Teething - What You Should Know

Medically Reviewed by Jabeen Begum, MD on May 10, 2024
9 min read

Teething is when your baby’s teeth start to come through their gumline. Another word for it is odontiasis.

When a baby’s teeth start to emerge, it can be uncomfortable. 

One common thought is that baby teeth cut through gums, causing the pain that can come from teething. But before the crown of a tooth appears, that part of your baby's gums has already been broken down by hormones.

So where does this pain come from then? As those hormones do their job, they cause the gums to swell and become tender, causing the pain.

When do babies start teething?

Most babies begin to teethe at around 6 months of age. Some may start teething earlier, and others begin much later. There’s no need to worry if your baby’s teeth come in on another timetable – it can be  different for every baby.

How long does teething last?

Teething isn’t a constant state – it happens whenever a tooth is ready to break through the gums. Most baby teeth (the primary teeth) come through by about 12 months and then the molars come in between 13 and 19 months. Typically, all baby teeth are out by the time babies are 3 years old.

baby teeth infographic

The symptoms aren’t the same for every baby, but they may include:

  • Swollen, tender gums
  • Fussiness and crying
  • A slightly raised temperature (less than 100.4 F)
  • Gnawing or wanting to chew on hard things
  • Lots of drool, which can cause a rash on the face
  • Coughing
  • Rubbing their cheek or pulling their ear
  • Bringing their hands to their mouth
  • Changes in eating or sleeping patterns

Teething can be painful, but it doesn’t usually make babies sick. Call your doctor if your baby has diarrhea, vomiting, rashes on the body, a higher fever, or coughing and congestion. These aren’t normal signs of teething.

You also should call the pediatrician if your baby’s gums are bleeding or you see any pus or swelling of their face.

Teething fever

Sometimes, babies who are teething get low-grade fevers. This is when the body temperature is slightly above normal, between 100 and 100.4 F. Some people call this teething fever. If your baby has a higher fever while teething, there is probably another cause aside from teething and you should contact your doctor.

Teething and swollen gums

Some babies may have red and swollen gums as a tooth tries to break through. This should ease as the tooth appears.

Teething rash

Teething rash isn’t really due to teething. The rash is caused by drooling, which often happens when babies are teething. This drool irritates the skin and it causes a rash. It can appear on their cheeks, chin, or even their chest.

To prevent rashes, keep a cloth handy so you can wipe away drool from your baby’s face, chin, or chest.

Babies who are teething and those who have ear infections can have some of the same symptoms, which can worry many parents. But there are some differences that will help you learn which your baby may have.

Both teething and ear infections could cause:

  • Fussiness and crying
  • Rubbing their cheek or pulling their ear
  • Bringing their hands to their mouth
  • Changes in eating or sleeping patterns

But these symptoms can occur with ear infections but not teething:

  • High fever
  • Severe pain
  • Fluid coming from the ear
  • Balance problems
  • A hard time hearing or responding to noise or sound

When and how teeth come in can be different for every baby and may be based on family history. But most of the time, the lower front two teeth come in first between 6 and 10 months, followed by the opposite top two teeth (between 8 and 12 months) and the two on either side of the upper front two teeth between 9 and 13 months. Next come the two on either side of the lower front teeth around 10 to 16 months, then the two first molars (upper and lower) appear between 13 and 19 months.

In all, 20 “baby teeth” will eventually be in place, usually by age 3.

If your baby is having trouble while teething, there are a few things you can try to help your little one feel better:

Teething toys

Offer your baby something to chew on, especially if it’s cold. A solid (not liquid) refrigerated teething toy or ring can be helpful. A cold pacifier, spoon, clean wet washcloth, or a rubber teether may also soothe sore gums. Avoid teethers filled with liquid, which can leak, or freezable teethers, which may be too cold or hard and may hurt your baby's mouth

Also, never tie a teether around your baby's neck – it's a choking hazard. 

Make sure to clean teething toys, washcloths, and other items after the baby uses them.

Teething medicine

Medicine that you rub on your baby’s gums to stop the pain of teething may not help. It quickly washes away in the mouth and may numb the back of their throat instead, making it hard for them to swallow.

In particular, stay away from over-the-counter teething gels and liquids that have the ingredient benzocaine. The FDA says this ingredient shouldn’t be given to children under 2. It can cause rare but serious side effects.

A small dose of a children’s pain reliever, such as acetaminophen (Tylenol) for babies at least 2 months of age and ibuprofen (Motrin) for babies 6 months and older, may help your baby. Don’t give ibuprofen to an infant under 6 months old, and ask your doctor before giving your baby any medication. Use it exactly as the doctor says.

Teething can be rough for you and your baby at first. But it will get easier as you both learn how to soothe each new tooth.

Other teething treatments

  • Teething biscuits. Most teething biscuits are not very nutritious and contain sugar and salt. If you give your baby these for teething pain, watch your baby while they are eating it. Chunks can break off easily and can lead to choking. 
  • Cold solid foods. If your child is eating solid foods, you might offer them cold applesauce or yogurt.

If you like to try natural products for pain relief for yourself, you may want to try them for teething pain. But it’s important to speak to your pediatrician or family doctor before trying any homeopathic or natural remedies. Some can pose health risks for your child.

Cold items. Anything cold will help to numb the pain for teething babies. Wet a clean washcloth, tie it in a knot, and chill it in the refrigerator for your baby to hold. You can also refrigerate their pacifier for relief as a natural remedy for the pain. Avoid gel-filled teething rings that you place in a freezer. These may be too hard for younger babies, and they may break or leak.

Massage. Gently rubbing your baby’s gums may provide relief. Wash your hands first, and then offer your baby a finger or knuckle to chew on. You can try rubbing in a circular motion to see if they like it. 

Breast milk. For some breastfed babies, nursing can soothe the teething process and they'll want to feed for longer. Other babies may find sucking painful for their gums and will have to bottle feed instead.

If your baby is breastfed, rubbing your finger in cold water before a feeding could prevent them from nipple chewing.

Offer water. If your baby is older than 6-9 months, you can offer cool water from a sippy cup, too.

Never put anything in your baby’s mouth that isn’t specifically approved to help soothe teething. Even some products described as teethers or teething aids aren’t safe choices, including ones that are:

  • Filled with liquid that can tear and spill
  • Made of breakable material, like plastic, that can possibly lead to choking. Also, some teethers can be made from harmful substances, like lead. Look for ones made of rubber.
  • Frozen solid – these can be too hard on a baby’s mouth

Teething gels

Teething gels, over-the-counter medications that you can rub on your baby’s gums, aren’t recommended because if you use too much, your baby can swallow some of the gel. As the gel passes over their tongue and down the throat, it may numb those areas as well.

Also, avoid using homeopathic teething tablets or gels that haven't been proven to provide benefits and may include harmful ingredients like belladonna, which can cause breathing trouble and seizures.

Teething necklaces

Child health experts don’t recommend teething necklaces. They’re dangerous and pose a strangulation risk. Babies also can choke if the necklace breaks and the beads are swallowed. Amber teething necklaces, which are said to release a pain reliever when heated, are also not a good idea. The benefits of using these are not proven.

Good oral hygiene is important, even before your baby has teeth:

  • If your baby is bottle-fed, don’t allow them to fall asleep while drinking. Milk or juice can pool in their mouth, and this can lead to tooth decay.
  • Until teeth start to come in, clean your baby’s gums with a wet washcloth or piece of gauze at least once a day.
  • Once they have teeth, clean your baby’s mouth the same way at least twice a day. After feedings is a good time for this.
  • After their first birthday, you can start to use a soft-bristled baby toothbrush with water and a small amount of toothpaste that doesn’t have fluoride in it. You can also start flossing between their teeth.

Your child should see a pediatric dentist when the first tooth appears, or no later than their first birthday.

After your baby starts teething, they need proper dental care. Tooth decay is the most common chronic disease of early childhood. Bacteria break down certain sugars, producing acid that deprives teeth of minerals and makes cavities. Your baby’s primary care doctor should be consulted about dental care, and a first dental visit should be scheduled at about 1 year.

If your baby has symptoms that may indicate there is something more than teething, like a high fever, check with your doctor too.

If your baby falls and hits their mouth, maybe damaging a tooth, contact your dentist as soon as possible so the tooth can be checked for cracks or breaks.

After reports of infant deaths, the FDA launched an investigation into some homeopathic (alternative medicine) teething tablets in 2017. They found inconsistent amounts of belladonna, which is a highly toxic substance also known as deadly nightshade.

If you have given your child homeopathic tablets, seek medical care right away if they have any of these symptoms:

  • Seizures
  • A hard time breathing
  • Muscle weakness
  • Flushed skin
  • Lethargy or excessive sleepiness
  • Excessive agitation
  • A hard time urinating
  • Constipation

Teething is a normal part of infant development. It can be painful for some babies, but it doesn’t make them sick. You might help ease your baby’s sore gums by giving them something to chew on, like a cold pacifier or teething toy. Luckily, once the tooth breaks through the gum, your baby should feel better. If your baby seems to be teething but also has a high fever and other symptoms, like diarrhea, call your doctor or take them to an emergency department. 

Do babies sleep more when teething? There’s no scientific proof that babies sleep more when teething. In fact, teething may do the opposite, making it hard for babies to sleep because they are in pain. If they sleep badly, they could seem sleepy because they are so tired.

Why do babies get fevers when teething? If a baby gets a fever from teething, it’s generally a mild one, no higher than 100.4 F. We don’t know why that happens. But if your baby has a higher temperature, it’s probably not because of the teething and it may be something else, like an ear infection.