Everything you need to know about teething

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While every baby photo is cute, it’s especially true of a snapshot of your little one showing off her first tooth. But getting to that major milestone isn’t easy. Teething is synonymous with lots of fussiness, crying and sleepless nights. Read on to find out everything you need to know about teething.

When do babies start teething?

Typically, the first teeth come in around six months of age, but babies can start teething anywhere from six to 13 months.

“I have seen them come in as early as four months, but that’s pretty rare,” says Jeffrey Bourne, a pediatrician at Providence Saint John’s Health Center in Santa Monica, California.

Alina Kulbasnaia/ Getty Images

In what order do baby teeth come in?

The front incisors usually come in first. Typically, the bottom front teeth will make an appearance first, but sometimes it’s the top two. Next, the canines will arrive. Your baby’s eight molars usually come in between her first and third birthdays, so she will be teething for a long time!

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How do I know if my baby is teething?

At two or three months, you’ll notice your baby start to drool and gnaw on things, including her fingers, your fingers and anything she can get her tiny little hands on. But that’s not a sign of teething, explains Bourne.

“Teething is really when the teeth start to erupt,” he says. “You might not see them initially, but you can actually feel little bumps on the gums within a day or two when they start coming through. That’s when it hurts: when they’re poking up through the gums.”

Now you’ve probably heard that fever and diarrhea can be signs of teething, but they’re not. “Teething can cause drooling and irritability, but that’s it,” explains Bourne. “The reason people think teething causes fever, diarrhea and other symptoms is because sometimes babies develop a lot of viral illnesses at that time, so it’s just a coincidence. But teething doesn’t cause a true fever.”

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Signs of teething

Bourne explains that there are only two signs of teething:

• Fussiness

You can’t blame your baby for being cranky during the teething process: It hurts! Irritability is a major symptom of teething. Expect your little one to be short-tempered and quick to cry during this period. Just like any other time when she is fussy, rocking, shushing and going for car rides can help soothe your baby.

• Drooling

You’ve been warned: Lots of drooling is in store when your baby is teething. That’s because teething stimulates saliva, so be prepared with lots of bibs. Seriously, we love this 10-pack of solid white bibs (they’re cheap!) for just this reason.

Oleksandra Troian/ Getty Images

Pediatrician-approved teething remedies: chewing on something cold

Bourne recommends putting a clean, wet washcloth in a plastic bag and letting it cool in the fridge—your baby will love gnawing on that.

This teething remedy is a classic for a reason: It really works! A teething ring gives your baby something to chew on, and that pressure can help soothe aching gums. “Parents can put a teething ring in the refrigerator to cool it down,” says Bourne. “That’s always very useful.”

One to try: Natural Wood & Silicone Teether

Inside Creative House/ Getty Images

Best for teething: teething toys

You should invest in a few teething toys, but not all teething toys are created equal. Bourne recommends the line of Sophie toys. “Those little giraffe toys are so popular,” he says. They aren’t just cute; they work! Pay attention to what teething toys are made of and how easy they are to wash: Your baby will be putting this toy in her mouth, so you want to be sure that it’s made of safe materials and easy to clean so you can prevent mould from growing inside.

These teething toys are also great, they’re made from organic rubber and there’s no hole in the bottom so water can’t get in.

Melpomenem/ Getty Images

Best for teething: pain medications

Some painkillers are perfectly safe to use as a teething remedy for babies six months and older. Bourne recommends acetaminophen or ibuprofen and suggests that you only give it at bedtime if your baby is fussy.

“It works really well, but I wouldn’t give it around the clock,” says Bourne. “Once at night for a couple of nights, when the teeth are coming through, is very reasonable.” Always check the label for the safe dosage for your baby’s weight.

One to try: Genexa Baby Acetaminophen

Inside Creative House/ Getty Images

Unsafe teething remedies: gels with benzocaine

This unsafe topical numbing cream is found in products like Orajel. The US Food and Drug Administration (FDA) advises parents not to use benzocaine teething gels on children younger than two, except under doctor supervision.

Benzocaine can cause methemoglobinemia, a serious condition that can cause death.

d3sign/ Getty Images

Unsafe teething remedies: amber necklaces

“There’s a substance called succinic acid found in amber from the Baltic region, and it’s supposed to go through the skin to create an analgesic effect,” explains Bourne on how amber necklaces can help teething babies. But so far, there is no research that these necklaces actually work.

“There’s no data at all that any is leached out into the skin,” he explains. Doctors also warn parents that the necklaces are a choking and strangling hazard. “They break really easily, so the beads can choke babies as well,” he says. “If parents insist on using them, we think babies definitely shouldn’t be put down in a bed or someplace where they’re not being supervised.”

But at the end of the day, Bourne sees no benefit to the beaded jewelry. “No pediatrician I know recommends them because there is really no benefit to them at all,” he says.

oksun70/ Getty Images

Unsafe teething remedies: homeopathic teething tablets

This controversial remedy caused a stir when Hyland’s Teething Tablets were pulled off the market because they contained varying amounts of belladonna, an herb used as a painkiller that can be toxic.

“But even after they were regulated, there are still problems with belladonna,” cautions Bourne. In late 2016, the FDA advised parents to stop using homeopathic teething tablets and gels after multiple incidents of babies and toddlers having seizures after taking them.

Jill Lehmann Photography/ Getty Images

This article was originally published on Apr 04, 2020

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Has my baby started teething? the signs to look out for | Baby & toddler articles & support

Teething signs can be confusing, and you’ll hear so many myths. Here we explore what teething is exactly and the signs you’ll see.

Teething happens at the same time as babies are vulnerable to illnesses and ailments as their immune system develops (Simon et al, 2015). This has led to confusion around what’s a sign of teething, and what’s not. Not just among parents but also some healthcare professionals (Plutzer et al, 2012; Eisenstadt et al, 2017).

This article sets out the signs and symptoms widely agreed to be caused by teething. It also flags up signs and symptoms not caused by teething that you’ll need to go and see your doctor about.

But first, the basics: What exactly is teething?

Teething is usually defined as when your baby’s teeth start to emerge through their gums (NHS, 2019). Their teeth were always there, within the jawbones, when they were born (Lyttle et al, 2015; NICE, 2020).

“Some babies are born with their first teeth. Others start teething before they are four months old, and some after 12 months. But most babies start teething at around six months (NHS, 2019).”

Your baby’s complete set of first teeth is usually on show by the time they’re three years old (NICE, 2020). These are often known as baby teeth or milk teeth, though the medical term is deciduous teeth because they will later fall out (NICE, 2020).

Even though your baby’s first teeth will fall out, they are very important for your baby’s health. This is because they help your child with eating solids and speech development, as well as self-esteem (Waite, 2019).

For a full guide to which teeth appear and when, see our month-by-month teething article.

Teething: What are the signs?

A baby’s teeth sometimes appear with no pain or discomfort at all (NHS, 2019). But others experience a constant, dull pain that gets increasingly intense in the four days before a tooth can be seen, before improving rapidly (Lyttle et al, 2015).

Your baby can’t use words to say they are in pain but you might see some pretty obvious signs there is a tooth on its way. The signs widely agreed to be sure indicators of teething include:

• drool, and lots of it –  teething babies can dribble way more than usual
• them biting and gumming down on anything and everything – that’s because the gnawing and chewing provides them with relief
• them being more grumpy, distressed and irritable than usual
• sore and red gums
• a loss of appetite.  

(Lyttle et al, 2015; Eisenstadt et al, 2017; NHS, 2019)

Other symptoms that might be signs of teething (although there is some debate over these) include:

• gum-rubbing
• sucking
• wakefulness
• ear-rubbing
• facial rash
• a runny nose
• a mildly-raised temperature, but still under 38°C, might also be a sign.

(Eisenstadt et al, 2017; NICE, 2020)

Your baby might be showing one of these signs or symptoms, or all of them. As with everything baby related, no two little ones are the same (Lyttle et al, 2015). In fact, teething signs can be so wide ranging, and vary so much from baby to baby that only one third of teething infants would experience any one of the signs above (Macknin et al, 2000).

Some studies go as far as to say none of these symptoms can be proven to be a sign of teething. They suggest the only way to know if your baby is teething is to examine their mouth – looking and feeling for an emerging tooth (Tighe and Roe, 2007).

Try laying your baby on your lap and sneaking a peek inside their mouth by moving their top or bottom lip or gently coaxing open their jaw. Use a clean finger to gently feel around their upper and lower gums systematically, one potential tooth spot at a time.

Is my baby teething or sick?

What’s not teething?

Other signs and symptoms that studies have found are generally NOT linked with teething include:

• congestion and coughs
• sleep disturbance
• runny poos, increased number of poos and nappy rash associated with them
• less interest or appetite for liquids
• rashes other than facial rashes
• fever over 38°C
• vomiting. 

(Eisenstadt et al, 2017; NICE, 2020)

It’s important you don’t assume one of these is a sign of teething. It could be something more serious and require medical attention.

Don’t confuse illness with teething

A fever and other clinically important symptoms, like diarrhoea, vomiting and rashes are very unlikely to be caused by teething, so make sure you talk to your GP or call NHS 111 (Tighe and Roe, 2007).

One study looked at 50 babies admitted to hospital with various conditions which the parents mistook for teething. In 48 of these children, a medical condition other than teething was identified, including a case of bacterial meningitis (Tighe and Roe, 2007).

Right, I’ve established my baby is teething. Now what?

You can read our articles on how to ease the pain associated with teething, and top tips proven to work.

It is also important to look after yourself, as your baby’s upset is likely to be stressful. You might feel exhausted too, as they’ll require even more of your attention. Our keeping calm with a crying baby article has some useful techniques you can try to keep your stress levels down.

This page was last reviewed in July 2022.

Further information

Our support line offers practical and emotional support with feeding your baby: 0300 330 0700.

You might find attending one of NCT’s Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

Read more about fever in children from the NHS.

For more information on what other illnesses may be causing their fever, this article from NICE is very useful.

If you are concerned, contact your GP or call NHS 111 where you can access urgent medical help fast.

NCT has partnered with the British Red Cross to offer courses in baby first aid.

References

Eisenstadt M, Malkiel S, Pollak U. (2017) It’s alright, ma (I’m only teething…) dispelling the myth from the teeth. Acad J Ped Neonatol. 3(4):555618. Available at: https://juniperpublishers.com/ajpn/pdf/AJPN.MS.ID.555618.pdf [Accessed 23rd July 2022]

Lyttle C, Stoops F, Welbury R, Wilson N. (2015) Tooth eruption and teething in children. Pharm J. 295:7883. Available at: https://doi.org/10.1211/PJ.2015.20069598

Macknin ML, Piedmonte M, Jacobs J, Skibinski C. (2000) Symptoms associated with infant teething: a prospective study. Pediatrics. 105:747-752. Available at: https://doi.org/10.1542/peds.105.4.747

NHS. (2019) Baby teething symptoms. Available at: https://www.nhs.uk/conditions/baby/babys-development/teething/baby-teet… [Accessed 23rd July 2022]

NICE. (2020) Teething. Available at: https://cks.nice.org.uk/topics/teething/#!diagnosissub:1 [Accessed 23rd July 2022]

Plutzer K, Spencer AJ, Keirse MJ. (2012) How first-time mothers perceive and deal with teething symptoms: a randomized controlled trial. Child Care Health Dev. 38(2):292-299. Available at: https://doi.org/10.1111/j.1365-2214.2011.01215.x

Simon AK, Hollander GA, McMichael A. (2015) Evolution of the immune system in humans from infancy to old age. Proc Biol Sci. 282(1821):20143085. Available at: https://doi. org/10.1098/rspb.2014.3085

Tighe M, Roe MFE. (2007) Does a teething child need serious illness excluding? Arch Dis Child. 92(3):266-268. Available at: https://doi.org/10.1136/adc.2006.110114

Waite C. (2019) Do baby teeth matter? Available at: https://bda.org/news-centre/blog/do-baby-teeth-matter [Accessed 28th September 2022]

what to do if the teeth are climbing and the baby has a poor appetite

Published: 05/06/2022

Reading time: 2 min.

Number of reads: 88362

Author of the article: Ponomareva Yuliya Vladimirovna

Pediatrician, candidate of medical sciences, allergist-immunologist

The appearance of milk teeth in a baby is a difficult stage in the life of both a child and all family members. This is one of the most common causes of restlessness, moody behavior and poor appetite in an infant in the first year of life. Let’s discuss how parents need to behave in order to help the baby get through this difficult period.

Contents: Hide

1. Timing of teeth
2. Changes in health
3. Refusal to eat
4. General rules
5. Baby porridge
6. Practical tips

Terms of appearance of teeth

The formation of teeth occurs in utero, that is, the baby is born already with a full set of teeth, which then wait for their time to erupt. The timing and pace of teething is an individual process, which depends primarily on heredity, as well as on external factors, such as the quality of drinking water and the nature of nutrition. For the first 3-4 months, the baby is exclusively breastfed, and the baby does not need teeth yet. By the 4th month of life, the infant is already deficient in the nutrients of breast milk, and the stage of the introduction of complementary foods begins. At this age, many children begin to appear the first milk teeth. However, the timing of the onset of eruption can be shifted to the second half of the year of life, this is also a variant of the norm. On average, by the 12th month of life, a child has 8 teeth and 20 by 2 years.

Health changes

The most common teething symptoms are increased salivation and itchy gums. During this period, the child pulls in his mouth and gnaws his own fingers and any objects that come across. In addition, the appearance of teeth is often accompanied by an increase in body temperature, changes in the stool and a decrease in appetite. The temperature can be above 38 ° C and disturb the child for several days. To make sure that changes in the baby’s health are associated with the appearance of milk teeth, carefully examine the child’s oral cavity. On examination, you will find redness and swelling of the gums at the site of the new tooth, and the child will respond even to a slight pressure on this area. Against the background of teething, the immune defense of the baby is often reduced, which leads to the appearance of symptoms of a viral or bacterial infection. Therefore, changes in the state of health of the crumbs can only be indirectly associated with teething. In every ambiguous situation, do not neglect the advice of a pediatrician.

Refusal to eat

Teething in babies is often accompanied by eating disorders – children become selective in choosing food, and often completely refuse food. Since the appearance of milk teeth is a long process, many parents of babies are concerned that during the period when teeth are being cut, the child does not eat almost anything. The contact of food with the gums increases pain, and the child does not perceive any food well. “How and what to feed the baby?” – this is the most pressing issue for parents of infants in the first year of life. Try to follow the general recommendations during this period, as well as some practical tips to help keep the child from being hungry.

General rules

Despite the difficult situation, do not force-feed. Forced eating can provoke disruption of the digestive tract and be the cause of improper eating behavior in the future. During this period, it is better to adhere to a free feeding regime according to the principle – often, but in small portions. If the mother is breastfeeding, then expect the frequency of feedings to change. The child has a need for frequent application, not only to satisfy hunger, but also for emotional calm. In the acute phase, refuse to introduce complementary foods and choose foods that minimally irritate the oral mucosa. During this period, salivation is increased in babies, therefore, to restore the water balance, periodically offer the baby drinking water for babies, allowed from birth. The baby has a desire to gnaw and bite everything, but during this period it is better to refuse solid food as much as possible, since sharp edges can additionally injure the mucous membrane and only worsen the situation. Among complementary foods, the most optimal choice during teething are cereal complementary foods.

Children’s porridge

What are the advantages of choosing children’s porridge as a priority in the baby’s diet during the period of the appearance of milk teeth? Firstly, it is a highly nutritious product – the combination of milk and cereals meets the needs of the child for energy and nutrients, even with a relatively small amount of the finished product. Secondly, the appropriate consistency of commercially produced baby cereals facilitates the assimilation of complementary foods. Bebi Premium baby cereals for children older than 4 months of age have a homogenized degree of grinding, which does not require additional gum grinding and reduces the load on the jaw apparatus. In addition, they are easily and without lumps diluted with water or breast milk at room temperature, which also reduces the severity of pain compared to warmer food. Fruit and vegetable complementary foods, despite the appropriate puree-like structure, are rich in organic acids, which can be a source of irritation of the delicate mucous membrane of the baby’s gums. During this period, another important advantage of the Bebi Premium line of children’s cereals is the reduced sugar content. Sugar is a good breeding ground for microbes that live in the oral cavity, its excess intake can increase the inflammatory process in the gums.

Practical advice

The pharmaceutical market offers a variety of topical gum pain relievers approved for use in children. However, it is recommended to use them very carefully and in consultation with the pediatrician in cases where pain significantly affects the condition of the crumbs. Be careful when using them, as swallowing the gel with painkillers can lead to severe toxic reactions. Safe aids are special teethers. Among them, the most effective are devices with a cooling gel or water inside. Offer the baby teethers before the next meal, and then he will eat complementary foods more calmly. Another simple and useful procedure is to massage the gums in the direction from the center to the corners of the mouth, avoiding impact on the eruption zone. Massage improves blood flow, activates growth processes and reduces tension in the gum area. Remember, teething is a natural physiological process, and the task of parents is to help the baby to overcome this difficult life stage as comfortably as possible.

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Teething and baby sleep

11/20/2016

179168

217

Why does not sleep at night

3–6 months6–9 months9–18 months1.5– 3 years

Author of the article

Natalya Trofimova

Natalya Trofimova

Senior Sleep Consultant, Pediatrician

Mother of two daughters

According to many parents, the most common cause of poor sleep is teething (dentation). The appearance of a new tooth often affects the condition of the child. The kid becomes whiny, “tame”, and sleep often worsens. This is due to irritation of the nerve endings by erupting teeth.

During the dental period, sleep patterns may become unpredictable, daytime naps may be shorter and more frequent, and the child may wake up more frequently at night. Laying down, especially for a night’s sleep, is delayed, it is more difficult for a child to relax. Even if your child is already able to fall asleep on his own, he may need help falling asleep and staying asleep.

When teething is difficult, a dark blue ball may appear on the gums – an eruption hematoma. Most often it goes away on its own, but sometimes you need the intervention of a dentist.

Child crisis calendar

When can we expect the first teeth?

Usually from 6–7 months. But for some children earlier, already from 4 months, and for someone later, this is also normal. The fists, fingers and everything that can fit in the mouth are there all the time, salivation increases, irritation around the mouth may appear, the gums swell and turn red, appetite changes due to pain (the child eats worse foods, prefers breast or bottle). Moms of babies often complain about biting the nipple, even with toothless gums it is painful. Let’s take a closer look at the symptoms.

Teething symptoms and help

What other than sleep disorders can be observed?

• Temperature rise – usually they talk about low, up to 38 ºС. But in practice, mothers also meet with temperatures up to 39 ºС for a couple of days, then a tooth appears, and everything goes away. If the temperature is below 38 ºС and it does not bother the child, he calmly eats and plays – do not be nervous and observe calmly. If the temperature is above 38.5 ºС, if the child is lethargic or very capricious, it is worth giving an antipyretic and contacting a pediatrician.
• Pain in the gums, itching and desire to gnaw everything, including the mother.

How to relieve itching:

• Use chilled soft teethers with water inside.
• Moisten the edge of the towel with water or compote and lightly freeze in the freezer.
• Give cold carrots to tear or dry – under control!
• Massage the gums with a special silicone tip on the finger.
• For severe discomfort, you can give half the age dose of an antipyretic 1-2 times a day with the permission of the pediatrician.

Gingival gels with local anesthetics are not currently recommended. In Europe and the USA, their use for children is prohibited due to various complications when swallowed.

There are safer formulations of gels that are approved from the first months of life. But in practice, they do not bring much relief.

• There may be loose stools up to 3-4 times a day – watery or with mucus, but without other impurities. The disorder is usually short-lived and resolves without medication. If complementary foods are introduced, it is worth temporarily canceling fruit puree.
• Runny nose – may be prolonged, discharge clear as water. Mucus is formed in the nose more than usual, due to increased blood supply to the jaws. Anatomically, the gums and nasal cavity are very close.
• There may be a cough that worsens when lying down. Breathing does not change. This goes away without treatment in a few days and is associated with profuse salivation and flow of mucus from the nasopharynx – babies do not cope well with swallowing large amounts of saliva. To alleviate the situation, you can use an aspirator. If the baby protests as soon as he sees the aspirator in your hands, try to induce a sneeze by laying the child on his stomach and tickling his nose with a feather or a string under funny jokes.

You can walk with normal health and temperature. Remember that all these manifestations during teething are short-lived and usually do not require treatment. But in case of any doubt, it is better to show the baby to the doctor.

Teething syndrome is a diagnosis of exclusion. It is suggested when all other possible causes of a rise in temperature have been ruled out.

How long does a new tooth interfere with sleep?

People used to write off a lot on “teeth”. Yes, when teething, a child can be capricious, irritable, have difficulty calming down and sleep worse. But not 3 months in a row. Sleep disturbances – frequent awakenings due to discomfort and long falling asleep – are possible for several days at the peak of eruption, with the direct passage of the tooth through the gum.

In Brazil, they conducted an interesting study: for 8 months, the condition of children in 47 families was assessed daily and their gums were checked. The study showed that teething could be combined with sleep disturbance, salivation, rash, runny nose, diarrhea, a short increase in body temperature, but all these symptoms were constantly noted only on the day the tooth passed through the gum and one day after. In the first days of eruption, there were no symptoms.

If constant nocturnal awakenings drag on for weeks, it’s probably not the teeth. Most likely, the regimen is not suitable for the child, or there are strong associations for falling asleep and prolonging sleep.

How to improve sleep during teething

Depending on the child’s age, the recommendations for the regimen of the child may be different, but there are general patterns:

• Allow more time for calming down before bed, especially in the evening. The usual bedtime ritual and a longer calm “bridge to sleep” will help.
• If the sleep is too short, the next wakefulness should be shortened, put to bed earlier for the next daytime nap or at night.
• If the child has a fever, let him sleep more than usual, do not wake him up from daytime sleep, return to his usual regimen later, when the situation has improved.
• If you refuse solid foods because of gum pain, do not refuse additional feedings to the breast or bottle, including at night.