The most common signs of an ear infection in babies include tugging or pulling at the ear, unusual fussiness, trouble sleeping, and fever. Because babies can’t tell you their ear hurts, you have to read their behavior and watch for physical clues. Ear infections are one of the most frequent reasons parents bring infants to the pediatrician, and knowing what to look for can help you act quickly.
Behavioral Signs to Watch For
Babies with ear infections often become noticeably more irritable than usual, particularly when lying down. That’s because lying flat increases pressure on the already-swollen middle ear, making pain worse. You may notice your baby crying more during feedings or at bedtime, or waking up repeatedly through the night when they normally sleep well.
Tugging, pulling, or rubbing at one or both ears is one of the most recognizable clues. Not every baby who touches their ears has an infection (babies explore their ears for all kinds of reasons), but ear-pulling combined with fussiness or fever is a strong signal. Some babies also lose interest in eating because the sucking and swallowing motions change pressure inside the ear and intensify pain.
Less obvious signs include trouble with balance or clumsiness in babies who are crawling or pulling themselves up, and reduced response to quiet sounds. If your baby seems less reactive to your voice or to soft noises around the house, fluid behind the eardrum could be muffling what they hear.
Physical Signs and Fever Thresholds
Fever often accompanies ear infections, especially in younger babies. The CDC flags a fever of 102.2°F (39°C) or higher as a reason to seek care promptly. For babies under 3 months old, the threshold is lower: any fever of 100.4°F (38°C) or above warrants a call to your pediatrician, regardless of the suspected cause.
Fluid or pus draining from the ear is another clear physical sign. This happens when pressure from the infection causes the eardrum to rupture slightly, releasing the trapped fluid. It looks alarming, but a small rupture typically heals on its own. The drainage itself, however, confirms an infection is present and should be evaluated.
Ear Infection vs. Teething
Teething and ear infections share several symptoms: irritability, fussiness, ear rubbing, and sometimes a mild fever. This overlap confuses a lot of parents. The key difference comes down to fever level and the combination of symptoms. Teething may cause a low-grade fever, but a fever of 101°F or higher, especially paired with ear-pulling and disrupted sleep, points more strongly toward an ear infection.
Ear infections also commonly develop during or right after a cold or upper respiratory illness. If your baby has had a runny nose and congestion for several days and then becomes extra fussy with a rising fever, the cold may have triggered a middle ear infection. Teething, by contrast, isn’t connected to respiratory symptoms.
Why Babies Get Ear Infections So Often
Babies and young children get far more ear infections than adults because of simple anatomy. The eustachian tubes, which connect the middle ear to the back of the throat and drain fluid, are shorter, narrower, and more horizontal in infants. This makes it harder for fluid to drain properly, and easier for bacteria from a cold or respiratory infection to travel into the middle ear and get trapped there.
Several environmental factors also raise the risk. A large study following nearly 8,000 children found that household secondhand smoke, having older siblings, and having pet birds in the home all increased the odds of ear infections. Breastfeeding, on the other hand, reduced the risk, with the strongest protective effect in the first two months of life. Interestingly, the same study found no significant association with daycare attendance, season of birth, or furry pets like cats and dogs.
How the Doctor Confirms It
Your pediatrician will look inside your baby’s ear with an otoscope, a small handheld device with a light and magnifying lens. In many cases, they’ll use a version that delivers a gentle puff of air against the eardrum. A healthy eardrum moves freely in response to that puff. If the eardrum barely moves, it signals fluid is trapped behind it. The doctor also checks the eardrum’s color and clarity, since an infected ear typically shows a red, bulging, or cloudy eardrum.
The exam is quick, though your baby probably won’t enjoy it. Holding your baby still for those few seconds is the hardest part.
Easing Your Baby’s Pain at Home
While waiting for a doctor’s appointment or for treatment to take effect, you can help your baby feel more comfortable. Infant acetaminophen is safe for pain and fever relief at any age (follow the dosing on the label based on your baby’s weight). Ibuprofen is another option, but only for babies 6 months and older.
A lukewarm, damp cloth held gently against the affected ear can soothe pain. Elevating your baby’s head slightly during sleep, by placing a thin pillow or folded towel under the mattress (not under the baby), helps reduce pressure in the middle ear. Don’t put any drops in the ear unless your doctor has specifically recommended them.
What Happens If Infections Keep Coming Back
A single ear infection that gets treated properly usually resolves without lasting effects. Recurring infections are the bigger concern. Repeated middle ear infections cause fluid to sit behind the eardrum for extended periods, leading to temporary hearing loss. In most cases, hearing returns to normal once the fluid clears and the infection heals.
The risk with frequent or chronic infections is that temporary hearing loss during a critical window of development can delay speech, language, and social skills. Babies learn to speak by hearing the sounds around them, and even mild, intermittent hearing loss during the first two years can slow that process. In rare cases, repeated infections cause permanent damage to the eardrum or the tiny bones of the middle ear, resulting in lasting hearing loss.
If your baby has three or more ear infections within six months, or four or more within a year, your pediatrician will likely discuss strategies to break the cycle, which in some cases includes a minor procedure to place small tubes in the eardrums to help fluid drain more effectively.