Teething

What Teething Is

Teething is the normal process of a baby's first teeth (the primary or "baby" teeth) pushing up through the gums. Most babies cut their first tooth somewhere between about 4 and 12 months, with around 6 months a common middle point. The bottom two front teeth usually appear first, followed by the top front teeth, and the full set of 20 primary teeth is usually complete by around age 3 (roughly between age 2 and 3). Timing varies widely from baby to baby and tends to run in families, so an early or late start is usually not a concern on its own. Teething is uncomfortable, but it is not an illness, and a healthy baby keeps feeding, sleeping, and behaving more or less like themselves through it. If your baby has no teeth at all by around 18 months, mention it to your pediatrician or dentist.

Signs, Symptoms, and What Teething Does Not Cause

Common signs include more drooling than usual, a strong urge to chew or bite on hands and objects, swollen or tender gums, fussiness, and disrupted sleep in the days around a tooth coming through. A drool rash on the chin or neck is common from constant wetness, and you may feel a hard, raised spot on the gum. Symptoms tend to come and go over a few days per tooth rather than lasting for months. It is just as important to know what teething generally does not cause: it does not cause high fever, diarrhea, vomiting, a runny nose, cough, or a body-wide rash. Teething may be linked with at most a slight, low-grade rise in temperature, but it does not cause a true fever (100.4 F / 38 C or higher), which points to a separate illness. If your baby seems genuinely sick rather than just uncomfortable, treat it as a possible illness, not "just teething."

Caring for It Safely

Most teething is managed with simple comfort measures. Gently rub the gums with a clean finger or a cool, damp washcloth, and offer a clean teething ring or solid silicone teether chilled in the refrigerator (not frozen solid, which is hard and can bruise gums). Wipe drool often and use a plain barrier ointment to keep the chin from getting raw. For pain that comfort measures don't ease, talk to your pediatrician about whether weight-based infant acetaminophen, or ibuprofen for babies 6 months and older (not for younger infants unless your doctor directs it), is appropriate and about correct dosing for your child's weight. Avoid certain remedies: the FDA warns against benzocaine teething gels (such as Orajel) in children under 2 because of a rare but serious blood condition called methemoglobinemia, and against homeopathic teething tablets, some of which have contained unsafe, inconsistent amounts of belladonna. Skip amber teething necklaces and other teething jewelry, which pose real strangulation and choking risks and are not proven to work. When in doubt about any product, check with your pediatrician first.

When to Call the Doctor, and the Bottom Line

Some symptoms signal illness rather than teething and should not be written off as a new tooth. Seek care right away for any fever of 100.4 F (38 C) or higher in a baby under 3 months old (a rectal temperature is the most reliable in young infants), and call your pediatrician promptly for a fever in an older baby that is high, persistent, or comes with other worrying symptoms. Other red flags include diarrhea or vomiting, a rash on the body (not just drool rash on the face), signs of dehydration such as far fewer wet diapers or a dry mouth, refusing to feed or drink, unusual sleepiness or being hard to wake, fast or labored breathing, inconsolable crying, or any symptom that worries you. The bottom line: teething is a normal, temporary discomfort of the first couple of years, managed with gum massage, safe teethers, and pediatrician-guided pain relief at the right weight-based dose; avoid benzocaine gels, homeopathic teething tablets, and teething jewelry, and never let "it's just teething" mask a real illness. This page is general information, not a substitute for medical advice. Talk to your pediatrician or healthcare provider about your child's specific situation.