Teething gets blamed for a great deal. Some of it is fair: sore gums, drooling, chewing on everything and a few broken nights. Some of it is not, and the things it does not cause are the ones worth knowing, because they are the signs that your baby needs a doctor rather than a teething ring.
The useful news is that the remedies that work are simple, cheap and mostly involve pressure and cold. The ones that have caused harm are the products marketed hardest.
The timeline is wide, and late is usually just late
Most babies get their first tooth at around six months, but anywhere from three months to just past the first birthday is within the normal spread. The two bottom front teeth usually arrive first, then the top front teeth, then outward from there. The full set of twenty baby teeth is generally in place somewhere around two and a half to three years old.
Order and timing run in families. A baby who starts late usually catches up, and there is no advantage to being early. If no teeth have appeared by about eighteen months it is worth mentioning to your pediatrician or dentist, mainly to check nothing else is going on.
Symptoms tend to cluster in the few days before a tooth breaks through and settle once it is out. It is not a continuous state for two years, even when it feels like one.
What teething actually looks like
Expect drooling, a strong urge to chew, gums that look swollen or slightly bruised over the tooth, fussiness, and sleep that goes backwards for a few nights. Some babies go off solid food but still drink happily, because sucking is more comfortable than chewing.
A small rise in temperature can happen. A genuine fever cannot be put down to teething, and neither can most of the other things attributed to it.
- Drooling, chewing and a swollen patch of gum over the emerging tooth
- Fussiness and disrupted sleep for a few days around each tooth
- A rash on the chin and cheeks from constant wetness, not from the tooth
- Eating less solid food while drinking normally
Pressure and cold do most of the work
Counter pressure on the gum is the most reliable relief. A clean finger rubbed firmly over the sore area for a minute often calms a baby faster than any product. A solid rubber or silicone teething ring gives them a way to do the same thing themselves.
Cold numbs the area. Chill a teething ring in the refrigerator, not the freezer, since something frozen rock hard can bruise gums. A clean wet washcloth twisted and cooled works just as well and costs nothing. For babies already on solids, cold food such as plain yogurt or refrigerated pureed fruit can help at mealtimes.
If your baby is genuinely distressed, an over the counter infant pain reliever is reasonable. Dose it by weight following the package directions for their age, and ask your pediatrician or a pharmacist if you are not sure which product suits your child.
- A clean finger rubbed firmly on the gum, for a minute at a time
- A teething ring chilled in the refrigerator, never the freezer
- A cold damp washcloth to chew on, changed for a clean one often
- Wiping the chin through the day to prevent a drool rash
The products to leave on the shelf
Amber and other teething necklaces and bracelets are a strangulation and choking risk, and US regulators have warned against them. There is no plausible mechanism by which they relieve pain and there have been real injuries.
Teething gels containing benzocaine have been the subject of an FDA warning for children under two because of a rare but serious blood condition, and homeopathic teething tablets have been the subject of warnings over inconsistent belladonna content. Rubbing alcohol or spirits on the gums is not safe for a baby at any amount.
Teething biscuits and rusks are the quieter problem. They are frequently sweetened and they dissolve into a sugary paste that sits against teeth that have only just arrived.
When it is not teething
Teething does not cause a high fever, diarrhea, vomiting, a cough, a rash over the body, or a baby who is limp, unusually sleepy or inconsolable. Those point to an illness that happens to have arrived at the same time, and they need a pediatrician.
Trust the pattern rather than the label. If your baby seems unwell rather than uncomfortable, or if symptoms carry on for more than a few days without a tooth appearing, have them checked. Attributing a real illness to teething is how things get missed.
Start brushing the day the first tooth arrives
As soon as a tooth is through, clean it twice a day with a soft baby brush and a smear of fluoride toothpaste about the size of a grain of rice. Baby teeth decay, and decay in a toddler is difficult and expensive to treat because of what it takes to keep a small child still and comfortable.
Aim for a first dental visit by the first birthday or within six months of the first tooth, whichever comes first. Early visits are short, mostly a look and a conversation about feeding, bottles and brushing, and they make later appointments far less frightening. If you do not have a family dentist yet, our directory searches every dental practice in the United States by town or ZIP code and shows the closest first, free and with no account.
The short version
- A first tooth anywhere between three months and just past a year is normal.
- Firm gum pressure and refrigerated (not frozen) objects give the most reliable relief.
- US regulators have warned against teething necklaces, benzocaine gels and belladonna tablets.
- A high fever, diarrhea or a very unwell baby is not teething and needs a pediatrician.
- Brush twice daily from the first tooth, and book a first dental visit by the first birthday.
Looking for a dentist?
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Frequently asked
Can teething cause a fever?
A slight rise in temperature can occur, but a genuine fever should not be blamed on teething. If your baby has a real fever, especially with diarrhea, vomiting, a rash or unusual sleepiness, treat it as an illness and contact your pediatrician. Missing an infection because it was attributed to teething is the risk here.
Are amber teething necklaces safe?
No. They present a strangulation risk if worn during sleep and a choking risk if beads come loose, and US regulators have warned against them. There is no credible mechanism for pain relief. A chilled teething ring or a cold washcloth gives your baby the pressure and cold they are actually looking for.
How long does each tooth take to come through?
Symptoms usually cluster in the few days before a tooth breaks through the gum and ease once it is out. It is uncomfortable in bursts rather than continuously. If your baby seems distressed for more than a few days with no tooth appearing, have them checked for something else.
This is general information to help you ask better questions, not a diagnosis. Anything happening in your own mouth needs a dentist who can look at it.