Teething: What to Expect and How to Help
That first tiny tooth peeking through your baby's gums is an exciting milestone—a visible sign of growth and development. But the process of getting there can be uncomfortable for your little one and exhausting for everyone. The reality is that teething affects babies very differently: some seem to barely notice it, while others are genuinely miserable. Understanding what's actually happening, separating teething myths from reality, and knowing which comfort measures truly work can help you navigate this phase with less stress.
Understanding the Teething Process AAP
Teething is the process by which teeth move through the bone and gum tissue to emerge into the mouth. While we tend to think of teething as something that happens in infancy, the primary (baby) teeth actually begin forming during pregnancy, developing beneath the gums and slowly moving toward the surface over months.
According to the American Academy of Pediatrics, most babies get their first tooth between six and ten months of age, though the range of normal is quite wide. AAP Some babies are born with teeth already visible (natal teeth), while others don't get their first tooth until after their first birthday. Both extremes are typically normal variations.
The lower central incisors (bottom front teeth) usually appear first, followed by the upper central incisors. Teeth tend to emerge in pairs—one on each side—though they may not appear simultaneously. By the time your child is about three years old, they'll typically have all 20 primary teeth. AAP
Each tooth follows a similar process: it moves through the bone, breaks through the gum tissue, and emerges into the mouth. This process can cause discomfort for a few days before and after each tooth emerges. However, the acute discomfort is usually limited to the days immediately surrounding eruption—not weeks or months of continuous symptoms. AAP
True Teething Symptoms: What the Research Shows AAP
One of the most helpful things you can understand about teething is what it actually causes versus what it doesn't. Research has carefully examined teething symptoms, and the findings may surprise you—teething causes milder symptoms than many parents expect, and some symptoms commonly attributed to teething are actually caused by other things.
Genuine teething symptoms include increased drooling, which occurs because the eruption process stimulates saliva production. You may notice your baby's chin and chest are frequently wet, and some babies develop a mild rash around their mouth or chin from the constant moisture. AAP
A strong desire to chew on things is another authentic teething symptom. The pressure of chewing provides counter-pressure that can relieve some of the discomfort from teeth pushing through. Babies may chew on their hands, toys, or anything they can get into their mouths. AAP
Fussiness and irritability are genuine teething responses, though typically mild to moderate rather than extreme. Your baby may seem more easily frustrated or more difficult to comfort than usual. Sleep may be slightly disrupted, particularly in the days immediately before a tooth emerges. AAP
Swollen, tender gums where the tooth is emerging are visible evidence of teething. You may be able to see or feel a small bump where the tooth is about to break through. Some babies have slight bleeding as the tooth erupts, which is normal. AAP
A mild temperature elevation is possible with teething, but this is where the research gets important. The AAP notes that teething may cause a very slight rise in body temperature, but true fever (temperature of 100.4°F or higher) is not a teething symptom. AAP If your baby has a fever, something else is causing it.
What Teething Doesn't Cause AAP
Perhaps more important than knowing what teething causes is understanding what it doesn't cause. The AAP and research studies have consistently found that several symptoms commonly blamed on teething are actually caused by other factors—usually the illnesses that happen to coincide with the teething months. AAP
High fever (100.4°F or above) is not caused by teething. The AAP emphasizes this point because fever in young infants can indicate serious illness and should be evaluated by a healthcare provider, not dismissed as "just teething." FDA If your teething-age baby has fever, they likely have an infection.
Diarrhea is not caused by teething, despite this being a persistent myth. The timing correlation—babies often have loose stools during the months they're teething—is likely explained by the fact that babies put many objects in their mouths during this period, increasing their exposure to germs. AAP
Severe diaper rash, runny nose, cough, and congestion are not teething symptoms. Again, these occur commonly during the teething months because babies are frequently exposed to viruses and bacteria, but teething itself doesn't cause these issues. AAP
Decreased appetite for milk or formula isn't typical of teething. While some babies may briefly eat less when a tooth is actively erupting, prolonged feeding refusal or dehydration warrants medical evaluation. AAP
Understanding this distinction is important because dismissing fever or illness symptoms as teething can delay treatment for actual infections that need attention.
Safe and Effective Comfort Measures FDA
When your baby is uncomfortable from teething, there are several evidence-based approaches that can provide genuine relief. The U.S. Food and Drug Administration and AAP recommend focusing on safe comfort measures. FDA
Chilled (not frozen) teething toys provide counter-pressure and numbing coolness that can soothe sore gums. Refrigerate teething rings rather than freezing them—frozen objects are too hard and can actually bruise sensitive gum tissue. FDA Look for solid teething toys rather than liquid-filled ones, which can break and leak.
A cold washcloth is a simple and effective comfort tool. Wet a clean washcloth, wring it out, and refrigerate it for an hour. Your baby can chew on the cool fabric for soothing relief. This is safe, inexpensive, and can be easily washed and reused. AAP
Gentle gum massage with a clean finger can provide relief. Wash your hands thoroughly, then gently rub your baby's gums with firm but gentle pressure. Many babies find this soothing, though some may resist if their gums are very tender. AAP
For babies who are eating solid foods, chilled soft foods can help. Cold fruit like refrigerated banana slices or chilled applesauce can provide comfort. A mesh feeder filled with cold fruit allows babies to gum and chew on something soothing while preventing choking. AAP
Distraction and extra comfort often help more than parents expect. Extra cuddles, gentle rocking, singing, and other soothing activities can help babies cope with mild discomfort. Sometimes teething babies simply need more attention and reassurance than usual. AAP
Using Medication for Teething Pain AAP
For significant teething discomfort that isn't relieved by other measures, infant pain relievers can be appropriate when used correctly. The AAP supports the judicious use of acetaminophen (Tylenol) or ibuprofen for teething pain when needed. AAP
Acetaminophen can be used at any age for teething babies, following age-appropriate dosing based on your baby's weight. Always use the measuring device that comes with the medication and follow package directions or your pediatrician's guidance. AAP
Ibuprofen (Advil, Motrin) can be used for babies six months and older. It provides both pain relief and anti-inflammatory effects. Again, dosing should be weight-based and follow package instructions. AAP
Never give aspirin to babies or young children due to the risk of Reye's syndrome. If you're unsure about dosing or which medication to use, contact your pediatrician's office. AAP
Pain medication should be used for significant discomfort rather than routinely. If your baby seems genuinely in pain—crying, difficulty sleeping, not themselves—a dose of appropriate pain reliever can help. But medication isn't necessary for mild fussiness that responds to other comfort measures. AAP
Products to Avoid: Safety Warnings FDA
The FDA has issued strong warnings about several teething products that pose serious safety risks. These warnings are based on documented cases of harm to children. FDA
Benzocaine products (such as Orajel and similar teething gels) are not recommended for children under two years old. The FDA warns that benzocaine can cause methemoglobinemia, a rare but serious condition that reduces the amount of oxygen carried in the bloodstream. FDA This condition can be life-threatening and has occurred in children using benzocaine teething products.
Homeopathic teething tablets and gels have also been the subject of FDA warnings. Some have been found to contain inconsistent amounts of belladonna (a toxic plant compound), and the FDA has received reports of adverse events including seizures in babies who used these products. FDA
Lidocaine (viscous lidocaine) should not be used for teething pain due to the risk of overdose. If swallowed in large amounts, lidocaine can cause seizures, brain damage, and heart problems. FDA
Amber teething necklaces pose choking and strangulation hazards. The AAP and FDA warn against these popular products because the beads can break off and be swallowed or inhaled, and the necklace itself poses a strangulation risk, particularly during sleep. FDA There is also no scientific evidence that amber releases any pain-relieving substance when worn against the skin.
Never apply alcohol to your baby's gums, a practice that was once common. Alcohol can be harmful to babies even in small amounts. AAP
The Teething Timeline AAP
Knowing the typical order and timing of tooth eruption can help you anticipate what's coming and identify which tooth might be causing current discomfort.
Between six and ten months, the lower central incisors (bottom front teeth) typically appear first. These are followed closely by the upper central incisors (top front teeth) around eight to twelve months. AAP
The upper lateral incisors (teeth on either side of the front teeth) usually emerge around nine to thirteen months, with the lower lateral incisors following around ten to sixteen months. AAP
First molars arrive between thirteen and nineteen months. These larger teeth often cause more discomfort than the front teeth because of their size. You may notice your baby is particularly fussy during this period. AAP
Canines (the pointed teeth next to the incisors) typically emerge between sixteen and twenty-three months. Second molars, the last of the primary teeth, usually arrive between twenty-three and thirty-three months. AAP
Remember that these are averages, and your child's timing may vary. Some children get all their teeth quickly over a short period; others get them more slowly. Both patterns are normal. AAP
When to Contact Your Pediatrician AAP
Most teething discomfort can be managed at home with comfort measures and occasional pain medication. However, certain situations warrant a call to your pediatrician.
Contact your doctor if your baby has a fever of 100.4°F or higher. As discussed earlier, fever is not a teething symptom and indicates another cause that may need evaluation or treatment. AAP
Call if your baby seems unusually ill, lethargic, or not themselves in ways that go beyond normal teething fussiness. Trust your instincts—you know your baby, and if something seems wrong beyond typical teething, it's worth checking. AAP
Seek guidance if your baby refuses to eat or drink for an extended period, as this can lead to dehydration. While mild appetite changes are normal during active teething, prolonged feeding refusal is not. AAP
Contact your pediatrician if you're unsure whether your baby's symptoms are from teething or from illness. It's always appropriate to ask, and your doctor can help determine whether anything else is going on. AAP
The Bottom Line
Teething is a temporary phase that every baby goes through. While it can be uncomfortable, understanding what to expect helps demystify the process. Remember that teething causes relatively mild symptoms—increased drooling, desire to chew, mild fussiness—and that fever and illness are not teething symptoms.
Focus on safe comfort measures: chilled teething toys, cold washcloths, gum massage, and extra cuddles. Use infant pain medication appropriately when needed. Avoid products with benzocaine, homeopathic teething tablets, and amber necklaces.
Each tooth that emerges brings you closer to the end of the teething journey. Clara is here to help you troubleshoot specific concerns, evaluate whether symptoms might be teething or something else, or just provide reassurance during those particularly fussy days.