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Baby Teething Symptoms: What's Normal and What Isn't
Teething causes drooling, fussiness and sore gums — but not fever, diarrhoea or serious illness. What's really caused by teething and how to safely soothe your baby.
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This article is for general information and is not a substitute for professional medical advice. Always consult your pediatrician or doctor about your child.
Aligned with AAP, WHO, NHS and CDC guidance.
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When do babies start teething?
Most babies begin teething between 4 and 7 months of age, though the normal range extends from as early as 3 months to as late as 12 months. The timing of teething is largely genetic — if you and your partner both teethed early, your baby likely will too. The first teeth to appear are usually the lower central incisors (the two bottom front teeth), followed by the upper central incisors a month or two later. By around 12 months, most babies have between 4 and 8 teeth, though some may have as few as 1 to 2 at their first birthday without this being a cause for concern.
Some babies experience noticeable discomfort and behavioural changes for days before a tooth appears; others seem to produce a tooth overnight with no apparent distress. This variation is normal and does not indicate that one baby is more sensitive or suffering more than another — it reflects differences in individual physiology. If no teeth have appeared by 18 months, a dental consultation is advisable to rule out any developmental issues.
Real teething symptoms (vs myths)
The symptoms that teething genuinely causes are relatively limited. Drooling is one of the most consistent signs — teething stimulates saliva production, and at 4 to 7 months babies do not yet have efficient swallowing coordination, so saliva pools and drips. This can cause a drool rash on the chin and neck, which is worth managing with gentle moisturising and gentle wiping. Gum swelling and tenderness in the area of the erupting tooth is real and causes discomfort, particularly when pressed (which is why babies chew on things). Fussiness, particularly in the evenings, is commonly reported. Slightly disrupted sleep around tooth eruptions is also reported by many parents.
What research has documented as genuine teething symptoms: increased drooling, gum irritation, desire to gnaw and chew, mild fussiness, and a possible very slight temperature elevation (not exceeding 38°C). These symptoms are real but mild and manageable.
What teething does NOT cause
This is critically important for parents to understand, because incorrectly attributing symptoms to teething can delay diagnosis and treatment of genuine illness. Teething does NOT cause: fever above 38°C (100.4°F), diarrhoea or loose stools, vomiting, runny nose, ear infections, rashes anywhere other than the drool rash on the chin, significant weight loss, or prolonged high-pitched screaming. These are symptoms of illness, not teething.
A landmark study published in the journal Paediatrics and replicated multiple times found that the maximum temperature elevation attributable to teething is about 0.12°C above baseline — far below any definition of fever. If your baby has a temperature above 38°C, they are sick and need appropriate medical evaluation. Many serious infections — ear infections, urinary tract infections, meningitis — are sometimes missed because parents and even some healthcare providers attribute symptoms to teething. When in doubt, have a sick baby evaluated by a doctor.
Safe ways to soothe teething pain
The most effective non-medication approaches for teething discomfort are physical. Chilled (not frozen) teething rings or toys are one of the most helpful tools — the coolness reduces inflammation and the pressure of chewing provides counter-stimulation. Never freeze teething rings, as frozen objects can cause tissue damage and frostbite to tender gum tissue. Silicone teething toys that can be chilled in the refrigerator are ideal. A clean finger gently massaging the sore gum area can also provide relief through counter-pressure.
If your baby is in significant distress — crying persistently, unable to sleep, not feeding — age-appropriate pain relief medication is appropriate. Infant paracetamol (acetaminophen) or ibuprofen (from 3 months for paracetamol, from 6 months for ibuprofen) can be used according to weight-based dosing. These are genuinely effective for teething discomfort and are safe when used correctly. Avoid teething necklaces and bracelets — these pose a strangulation and choking hazard and have caused infant deaths.
Teething order: which teeth come when
Primary (baby) teeth usually appear in a predictable order, though there is variation. The typical sequence: Lower central incisors (6-10 months) → Upper central incisors (8-12 months) → Upper lateral incisors (9-13 months) → Lower lateral incisors (10-16 months) → Upper first molars (13-19 months) → Lower first molars (14-18 months) → Canines / upper and lower (16-22 months) → Second molars, lower then upper (23-31 months). By age 3, most children have all 20 primary teeth.
The molars are often reported as causing the most significant discomfort — they are larger and have a broader surface breaking through the gum. Parents often notice a return of teething symptoms around 13 to 19 months when the first molars appear, even in children who seemed to manage earlier teething easily. Good dental hygiene should begin with the first tooth: wipe or brush twice daily with a tiny amount of fluoride toothpaste (a grain of rice until age 3, then a pea-sized amount) and arrange a first dental visit around the first birthday.
Frequently Asked Questions
Does teething cause fever?
This is one of the most persistent and harmful myths in paediatrics. Teething does NOT cause fever. Multiple well-designed studies have found that while babies may have a very slight elevation in temperature (up to 38°C / 100.4°F) around teething, true fever (above 38°C) is not caused by teething and is always caused by an illness or infection. Because babies begin teething around 6 months, which is also when maternal antibodies start declining and babies become more susceptible to infections, the timing of illness and teething often coincide — but teething is not the cause of the fever. A baby with fever above 38°C needs to be assessed for illness, not attributed to teething.
What are the first signs of teething?
The earliest teething signs typically appear 3 to 5 days before a tooth actually emerges. The most common first signs are increased drooling (sometimes dramatic), chewing and gnawing on hands, toys, or hard objects, swollen and tender gum tissue in the area where the tooth is coming, and increased fussiness — particularly in the evenings. Some babies also show reduced sleep quality and slightly increased wakefulness in the days around a tooth eruption. Not all babies show obvious signs; some teeth appear with very little warning.
Are teething gels safe?
Topical teething gels containing benzocaine (a local anaesthetic) are not recommended by the FDA, the AAP, or most paediatric dental organisations for children under 2. Benzocaine can cause methemoglobinaemia — a rare but serious condition that reduces the blood's ability to carry oxygen. In the UK, gels containing choline salicylate are also not recommended for children under 16. Teething gels with chamomile extract or homeopathic formulations are marketed widely but have no evidence of efficacy beyond placebo. The safest soothing approaches are physical: chilled (not frozen) teething rings, gentle gum massage with a clean finger, and age-appropriate pain relief medication if significant distress is present.
How long does teething pain last for each tooth?
The most intense discomfort associated with each tooth typically lasts only a few days — specifically the 3 to 5 days around when the tooth actually breaks through the gum. Before the tooth is visible, the gum tissue becomes swollen and tender; this is the peak discomfort phase. Once the tooth has erupted through the gum, discomfort usually subsides quickly. However, since babies typically have 20 primary teeth and erupt them over a span of about 2 years (from approximately 6 months to 2.5 years), there are many individual tooth eruption episodes during this period, which can make teething feel like a prolonged and continuous experience.
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