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Ear Infection or Teething? How to Tell Which One Is Causing Your Toddler's Irritability
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  • Ear infections are one of the conditions most challenging to diagnose among infants and toddlers. They hardly exhibit any signs, and often these symptoms may be mistaken as signs of other things. Add the fact that babies are still verbally unable to communicate, and you may just find yourself taking trips to the doctor for suspected ear infections more often than you’d like to.

    What is an ear infection?

    Medically speaking, an ear infection, or otitis media, is when the middle ear becomes infected and inflamed, which can be painful.

    Most kids get an ear infection before they turn 2 years old. The reason is the eustachian tube, a passageway between the middle ear, which is located behind the eardrum, and the throat. In babies, these tubes are short, thus unable to keep some germs out. As your child gets older, the eustachian tubes grow longer and provide better protection. Ear infections are not contagious, but one could catch a cold that could trigger an ear infection.

    According to Amanda Dempsey, M.D., Ph.D., assistant professor of pediatrics and communicable diseases at the University of Michigan Health System, “When a child gets a cold, the tiny tubes can swell and prevent fluid from draining. 

    “The fluid can get trapped behind the eardrum and create an ideal moist environment for viruses or bacteria in a child’s throat and ears to multiply and cause an infection.”

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    Symptoms of ear infection

    It will be difficult to check the middle ear for any signs of infection, but other symptoms will be visible. A person with an ear infection may experience any of the following:

    • dizziness
    • nausea
    • problems with balance
    • fever
    • earache

    In babies and toddlers, you may notice your child pinching or tugging at her ears, and having unusual crying episodes accompanied by fever. She will also be irritable and may not be keen on sleeping, likely due to the earache. There may also be fluid draining from the ear. In more severe cases, your child may have diarrhea and refuse to eat.

    These symptoms are easy to confuse with the signs of teething, especially when your child is in that stage (between 4 and 7 months old, some beyond a year old). If your child seems to be in a lousy mood longer than usual (two to three days) and cannot be consoled, it’s best to have her checked by the pediatrician, so she can give her a thorough check-up. (It may not even be an ear infection, after all!)

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    Diagnosing ear infection

    The doctor is the best person to determine if your child has an ear infection. Using an otoscope, the doctor will look inside your child’s ears, nasal passage and throat. He will check if the eardrum is red and if there is fluid behind the eardrum, which would indicate an infection.

    The pediatrician will also lightly blow into your child’s ear to see if the eardrum will move. Minimal movement of the eardrum or no movement would mean it is filled with fluid (pus).

    Treatment for ear infection

    An infection caused by bacteria will commonly be treated with an antibiotic. Pain relievers like ibuprofen may also be prescribed to soothe your child. Observe your toddler in the next few days to see if her condition will improve.  

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    However, in the U.S., extra care is being observed in dispensing prescriptions for antibiotics. The American Academy of Pediatrics, together with the American Academy of Family Physicians, issued guidelines in 2004 regarding the treatment of kids’ acute ear infections.

    The guidelines ask that doctors not be too quick in prescribing antibiotics to give the immune system a chance to fight off the infection and heal the body on its own. According to studies, acute ear infections go away on their own about 80% of the time, and that more than half of the cases exhibit improved conditions within a day or two.

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    At home, you can alleviate your child’s pain from ear infection with the following:

    1. Keep your child hydrated. 

    Swallowing relieves the pressure in the ear and eases discomfort. 

    2. Use warm compress.

    A warm towel placed over your child’s ear intermittently may help relieve the swelling. Be extra wary of the temperature so as not to worsen the situation — too hot and you’ll have another problem!

    3. Keep your child’s head elevated.

    This will improve her sinus drainage and relieve pressure from the ear. 

    4. Ask the doctor if you can give acetaminophen.

    Your doctor will prescribe the correct dosage and frequency. This will address not only the pain but the fever as well.

    What if the ear infection keeps coming back?

    One or two instances of ear infection before your child turns two is considered normal. But any more than that, say, three or four in a year, may already be considered chronic. 


    “Kids who have frequent infections spend a lot of time feeling ill, and if fluid in their ears doesn’t clear between infections it can interfere with hearing and language development,” says Nancy Young, M.D., head of otology at Children’s Memorial Hospital, in Chicago. Bring it up with your child’s pediatrician if this is the case, and she can advise you on next steps that may be taken.

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    Additional tests for ear infection

    If the doctor deems it necessary, she may recommend that your child undergo more tests to rule out other conditions. Some of these tests may be:

    Tympanocentesis - if your child does not respond well to the prescribed medicines, your doctor may want to test the fluid coming from the ear for viruses and bacteria. Using a tiny tube, the eardrum will be pierced to drain fluid.

    Tympanometry - it is done to gauge the movement of the eardrum, giving the doctor an idea of how much pressure there is within the middle ear.

    Acoustic reflectometry - this test checks the amount of sound reflected in the eardrum, which would indicate if there is fluid buildup in the middle ear. The more fluid there is, the more sound will be reflected in the eardrum. 

    He may also refer you to a hearing or speech therapist if he suspects other complications.

    How to prevent ear infections

    It is important to take precaution to avoid getting infections, especially when young kids are involved. Do not smoke around your child, and wash your hands regularly before coming near her. Keep away from people who have cough and colds.

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