Teething Syndrome in Babies

Teething syndrome symptoms

Research that tracked babies daily found that teething symptoms cluster in the 4 days before a tooth breaks through, the day it appears and the 3 days after. The most common are:

• drooling, which can cause a rash on the chin and chest
• biting and chewing on hands, toys and fingers
• rubbing or pulling at the gums
• red, swollen or tender gums over the tooth
• irritability and crying, more than usual
• waking more at night
• reduced appetite for solids, or fussing during feeds
• rubbing the ear or cheek on the same side as the tooth
• a slight rise in temperature, below fever level

Many babies cut teeth with no noticeable symptoms at all.

What teething does not cause

Parents often blame teething for illness, and doctors see infections missed for this reason. Major pediatric guidelines are clear that teething does not cause:

• fever of 38 °C (100.4 °F) or higher
• diarrhea or vomiting
• a runny nose or cough
• a body rash, apart from drool rash
• prolonged crying that cannot be settled

Babies from 6 months onward also lose antibodies from their mother and start getting frequent viral infections, which coincides with teething. A fever during teething usually has another cause, such as an ear infection, roseola or hand, foot and mouth disease. If your baby has a fever, treat it as a possible illness.

Baby teeth timeline

Timing varies widely. A few babies are born with a tooth (natal teeth), and some get their first tooth after their first birthday. Teeth often come in pairs. The large molars can cause more discomfort than front teeth.

How to tell teething from illness

Safe teething relief

• Something firm to chew: solid rubber or silicone teething rings, chilled in the fridge, not the freezer. Frozen items can injure gums.
• Gum massage: rub the gums with a clean finger or a cool, wet washcloth.
• Cold foods for babies already on solids: chilled fruit purée or yogurt. Use a mesh feeder only under supervision.
• Wipe away drool often and use a barrier cream to prevent chin rash.
• Pain relief: for babies older than 3 months, acetaminophen (paracetamol), and from 6 months, ibuprofen, can be used occasionally for significant discomfort. Follow the label dose for your baby's weight, and ask a pharmacist if unsure. Never give aspirin to children.
• Comfort and routine: extra cuddles and keeping the usual sleep routine.

Teething products to avoid

• Benzocaine and lidocaine gels: the FDA warns against them for children under 2. Benzocaine can cause methemoglobinemia, a rare but dangerous blood disorder, and numbing the throat can affect swallowing.
• Homeopathic teething tablets and gels: some have contained variable amounts of belladonna, and the FDA has warned against their use.
• Amber, wood or bead teething necklaces and bracelets: risk of strangulation and choking. There is no evidence they work.
• Teething biscuits with added sugar, and dipping pacifiers in sugar or honey. Never give honey to babies under 12 months.
• Liquid-filled teethers that can split, and anything small enough to choke on.

Caring for new teeth

Start brushing as soon as the first tooth appears, twice a day, using a soft baby toothbrush and a smear of fluoride toothpaste the size of a grain of rice. Book a first dental visit by the first birthday or within 6 months of the first tooth. Do not put your baby to bed with a bottle of milk or juice, which causes tooth decay.

Frequently asked questions

What are the symptoms of teething syndrome?

Common symptoms are drooling, chewing on objects, gum rubbing, swollen or tender gums, irritability, waking more at night and reduced appetite. They usually cluster in the few days before and after a tooth comes through. Some babies have few or no symptoms.

Can teething cause a fever?

Teething can cause a slight rise in temperature, but not a true fever. A temperature of 38 °C (100.4 °F) or higher is a sign of illness, such as a viral infection or ear infection, and should be assessed, especially in babies under 3 months.

Does teething cause diarrhea or a runny nose?

No. Studies and pediatric guidelines do not support teething as a cause of diarrhea, vomiting, runny nose or cough. These usually come from common infections, which are frequent at the same age. Watch for dehydration and call a doctor if symptoms persist.

How long does teething pain last?

Discomfort usually lasts about a week per tooth, from around 4 days before the tooth breaks through to a few days afterward. Babies cut teeth in phases between about 6 months and 3 years, with quiet periods in between.

Are teething gels safe for babies?

Gels containing benzocaine or lidocaine are not recommended for children under 2 because of rare but serious side effects, and their effect washes away quickly. Chilled teething rings, gum massage and, if needed, acetaminophen at the correct dose are safer options.