Drool-soaked shirts, fingers in the mouth and a baby who wants to chew on everything: welcome to teething! Teething is a normal part of development, but it can be uncomfortable for babies and tiring for parents. It is also often blamed for symptoms it doesn't actually cause. This guide explains when teeth usually appear, which symptoms are typical, safe ways to ease sore gums and how to care for your baby's first teeth.
When Do Babies Start Teething?
Most babies get their first tooth at around 6 months of age, but the normal range is wide. Some babies start as early as 3 or 4 months, while others don't get a first tooth until after their first birthday. Timing often runs in families. A few babies are even born with a tooth.
Teeth usually come in a predictable order:
- The two bottom front teeth (lower central incisors)
- The two top front teeth (upper central incisors)
- The teeth on either side of the front teeth (lateral incisors)
- The first molars
- The canine teeth
- The second molars
By about age 3, most children have all 20 of their primary (baby) teeth. If your baby has no teeth by around 18 months, mention it at a checkup.
Common Teething Symptoms
Many babies have few or no symptoms, while others are fussy for a few days before each tooth breaks through. Typical signs include:
- Extra drooling, which can cause a mild rash on the chin or cheeks
- Chewing or gnawing on hands, toys and anything within reach
- Irritability or crankiness
- Sore, red or swollen gums
- Rubbing the face or pulling at the ears
- Mild changes in sleep or appetite
What Teething Does Not Cause
Teething may cause a very slight rise in temperature, but it does not cause a true fever. Teething also does not cause diarrhea, vomiting, a runny nose, cough or a body rash. Babies who are teething are often at the age when they start getting more infections, so it's easy to blame the teeth. If your baby has a temperature of 100.4°F (38°C) or higher, or seems sick, look for another cause and contact your pediatrician as needed. Read more about what to do when your child has a fever.
Safe Ways to Soothe Teething Pain
Gum massage
Wash your hands and gently rub your baby's gums with a clean finger or a soft, damp washcloth for a minute or two. The pressure often brings relief.
Something cool to chew
Offer a firm rubber teething ring or a clean, wet washcloth that has been chilled in the refrigerator. Cold helps numb sore gums. Avoid freezing teething rings solid, since very hard, icy items can hurt the gums, and avoid liquid-filled rings that could break.
Cool foods for older babies
If your baby already eats solid foods, chilled foods such as applesauce or yogurt may feel good. Always supervise eating and avoid hard foods that could be a choking hazard.
Wipe away drool
Gently pat your baby's face dry throughout the day and apply a thin layer of a fragrance-free barrier ointment to prevent drool rash.
Pain reliever if needed
If your baby is very uncomfortable, ask us whether acetaminophen is appropriate and what dose to use. Ibuprofen can be used for babies 6 months and older. Dose by weight, use the measuring device that comes with the medicine, and never give aspirin.
Extra comfort
Sometimes the best remedy is extra cuddles, a calm routine and patience. Teething discomfort usually lasts only a few days around each new tooth.
Teething Products to Avoid
- Numbing gels and liquids with benzocaine or lidocaine. The U.S. Food and Drug Administration (FDA) warns against using these in babies and young children because they offer little benefit and can cause serious side effects, including a dangerous blood condition.
- Homeopathic teething tablets and gels. The FDA has warned parents not to use them.
- Teething necklaces and bracelets made of amber, wood, marble or silicone. These pose a risk of choking and strangulation.
- Honey or sugar on pacifiers. Honey can cause infant botulism in babies younger than 1 year, and sugar promotes tooth decay.
Caring for Your Baby's First Teeth
Baby teeth matter. They help children chew, speak clearly and hold space for adult teeth. Tooth decay is one of the most common chronic conditions of childhood, but it is largely preventable.
- Before teeth appear, wipe your baby's gums with a soft, damp cloth after feedings.
- When the first tooth appears, brush twice a day with a soft infant toothbrush and a smear of fluoride toothpaste about the size of a grain of rice. From age 3, use a pea-sized amount.
- Don't put your baby to bed with a bottle of milk, formula or juice. Liquids that pool around the teeth during sleep cause decay.
- Skip juice before 12 months, and offer water in a cup after 6 months.
- Start the first dental visit by your child's first birthday.
- Ask about fluoride varnish. Pediatricians can apply fluoride varnish to baby teeth during well visits to help prevent cavities.
Teething Questions Parents Often Ask
Why does my baby pull at their ears while teething?
Pain from the gums, especially from the back molars, can be felt in the ears and jaw, so ear rubbing is common. However, ear pulling with fever, unusual crankiness at night or cold symptoms can also be a sign of an ear infection. If you aren't sure, have your baby checked. Learn more about ear infections.
Are teething biscuits a good idea?
Many teething biscuits contain sugar and can crumble into pieces that are hard for young babies to manage. A chilled teething ring or washcloth is usually a better choice. If you do offer food to chew on, stay close and watch your baby the whole time.
Does teething affect sleep?
Some babies wake more often for a few nights when a tooth is coming in. Keep your usual bedtime routine, offer comfort, and avoid starting habits you don't want to continue once the tooth is through.
When to Call the Pediatrician
Contact our office if your baby:
- Has a fever of 100.4°F (38°C) or higher, especially if younger than 3 months
- Has diarrhea, vomiting, a rash on the body or cold symptoms
- Is unusually fussy and can't be comforted
- Is not drinking well or has fewer wet diapers
- Has swelling, pus or bleeding in the gums that doesn't stop
The Bottom Line
Teething is a normal milestone that most babies get through with a little extra comfort. Stick with simple, safe remedies like gum rubbing and chilled teething rings, avoid numbing gels and teething jewelry, and remember that fever and diarrhea are not caused by teething. Start brushing as soon as the first tooth appears, and bring your questions to your baby's next well-child visit. For more newborn and infant tips, see our newborn care guide.
This article is general health information for parents and is not a substitute for medical advice. If you are worried about your child, contact your pediatrician; in an emergency, call 911.
Questions about your child's health?
Our Chestertown pediatric team cares for newborns, children and teens. Request an appointment, read our new patient information or browse more articles on the pediatric health blog.