Teething 101: How to Tell When Your Baby is Teething and What to Do Next

If you’re a parent, you probably know that teething can be uncomfortable—for you and baby. But knowing what symptoms to look for—and when to look for them—can help you choose the right remedies to soothe baby’s gums and ease his pain.

Does this sound familiar?

You’re starting to get the hang of this baby thing. Your feeding and diapering routines have machine-like efficiency, and you’re finally sleeping for longer than four hours at a time. Then, baby starts teething.

When your baby is refusing to eat or nap and seems fussier than normal, teething may be to blame. Then again, there may be another issue at play, and when baby’s behavior seems to change overnight, it can be hard to determine the cause.

Teething happens for most infants between four- and twelve-months-old. Usually, the process is only mildly uncomfortable, but some infants have more discomfort than others. There may be drooling, nonstop crying, irritability, and even a refusal of milk and naps.

Teething (particularly the need for baby to chew on hard objects) may have an evolutionary purpose, as it primes baby’s mouth for ongoing oral development and prepares the jaw for erupting teeth. So despite the frustration you and baby may feel, it’s critical that you support this process to ensure that his teeth, mouth, and jaw grow correctly. (And, of course, getting him out of pain is important, too.)

This post is designed to help you understand whether your baby is, in fact, teething, what to expect during the process, and what you can do to ease your baby’s discomfort.

There are lots of teething remedies out there, including amber and silicone teething necklaces, chewing toys, biscuits, and medications. With that in mind, this article will also explain which treatments are safe and effective, which ones you should avoid, and which remedies help promote the proper development that will help your baby grow into a child (and, later, an adult) with straight teeth and correct facial growth.

What is teething?

While infants seem to be born with no teeth, they actually have a full set of baby teeth sitting just under their gums. Teething is the process through which those teeth cut, or break through, and become visible above the gum line.

By the time your little one is three years old, he should have a full set of 20 teeth. (Then, later in childhood, those baby teeth will begin to fall out and be replaced by permanent teeth.)

During teething, baby teeth break through the gums in stages. The order teeth appear is generally similar for most babies and typically starts with the bottom teeth. Sometimes teeth appear out of order, however, but this is not generally cause for concern. (1) In more rare cases, some babies will even be born with a tooth or two.

Simply put, a wide variety of teething experiences still fall within the range of healthy and normal.

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When does teething start and end?

The age babies start teething is genetic—if you got your first teeth early, chances are your baby will, too. (2)

As mentioned, the first teeth to push through will generally be the bottom central incisors around 4-7 months of age, followed by the top central incisors, which erupt around between 8-12 months.

Central incisors are commonly known as “front teeth.” The upper lateral incisors, which are the teeth flanking the central incisors, generally start to appear around 9-13 months, followed by the lower lateral incisors around 10-16 months.

Your child’s first molars will come in next, starting with the upper first molars around 13-19 months. The lower first molars follow, typically around 14-18 months.

The upper canines, also called cuspids, emerge as your baby becomes a toddler, around 16-22 months. The lower canines follow shortly after, around 17-23 months.  Canines are named for their resemblance to a dog’s fang, although they can also appear more flattened.

Around 25-33 months, the upper second molars emerge. Their appearance typically signals the end of your baby’s teething process.

Again, these are general guidelines, and your baby’s teething process may be different. However, if your child hasn’t had any tooth eruptions by 18 months, consult a dentist or doctor.

What are teething symptoms?

While some babies have no symptoms, others may experience one or more of the following:

• • Loss of appetite: Your baby may not want to eat as much as normal, due to inflamed gums.
  • Drooling: Babies frequently drool, but with teething you may see more than normal.
  • Sore and tender gums
  • Gnawing on solid objects: When teething, your baby may want to put his mouth on everything in sight to soothe his sore gums. So this is a good time to be especially careful about leaving objects around that aren’t safe.
  • Mild fussiness and crankiness: Your baby may be more irritable than normal. He is experiencing discomfort without understanding the cause, so it’s normal for him to feel upset.
  • Red and swollen gums: The visible signs of inflammation may allow to quickly see that baby is teething

What symptoms are probably not related to teething?

Teething may cause discomfort, but it is unlikely to cause excessive crying. Additionally, while your baby may be more fussy than usual during the day, he shouldn’t have any sleep problems as a result of teething.

Additionally—and despite pervasive rumors to the contrary—teething does not cause a runny nose, diarrhea, a fever, or diaper rash. (3) However, the small openings in your baby’s gums may make it easier for your baby to contract a virus that may cause a cold or illness.

Please remember that if your child looks or acts very sick, it’s important to visit a doctor. The symptoms of teething should be mild.

How can I ease teething discomfort?

Discomfort while teething is completely normal, but there are steps you can take to help your baby through the process.

A gum massage is one of the safest, easiest, and best remedies for teething. Try rubbing your babies gums with a clean finger, a washcloth, or a gum-rubbing finger pad.  You can also try rubbing your baby’s gums with a cold spoon or moist gauze.

Cold food like chilled applesauce or pureed fruit may soother sore gums.

Teething biscuits may provide relief for sore gums, but I don’t recommend them, as they are a processed that is high in carbohydrates. If you want to give your baby an edible teether, I recommend filling a mesh feeder with chopped apples or other fruit. This will keep baby’s oral microbiome balances and minimize the risk of decay.

The best teething rings and toys

Teething rings are a tried-and-true teething remedy, as chewing action puts pressure on the gums that provides relief. Chilling the ring in the fridge may provide additional relief, but you should never freeze the ring. If frozen, the ring may break in your baby’s mouth or cause pain from being too rigid.

Keep in mind, though, that not all teething rings are created equal.

Be sure to look for rings that are made of solid, BPA-free plastic. BPA may be toxic and can cause developmental, reproductive, neurological, and immune system issues, as well as other concerns. Meanwhile, liquid- or gel-filled rings can chemicals that could be dangerous if the ring is broken.

I actually recommend wood teething toys instead of plastic teething rings because their firmness promotes proper chewing and facial development, and there’s none of the toxic risk. My granddaughter loves this wooden rattle by Homi Baby. It’s small enough for her to grab and is also sealed with organic virgin coconut oil, which is safe for babies.

Despite their growing popularity, you should avoid teething bracelets and necklaces designed for baby to wear. They are typically made from a material that is too soft to benefit oral development and prepare the jaw for erupting teeth, and the American Academy of Pediatrics has already issued strangulation and choking warnings. (4)

Other natural teething remedies

For parents who prefer herbal or all-natural teething remedies, rosehip, chamomile, or clove can be boiled into a tea, chilled, and then put on a washcloth to rub across baby’s gums.

And when nothing else works, distraction is a time-honored parenting technique. A favorite toy can take your baby’s mind off the discomfort, as can a movie or having a favorite book read to him.

Teething is a normal and natural process that, hopefully, shouldn’t be too disruptive to your baby’s life (or yours). Some babies have no teething symptoms, but if they do, they typically pass in within a week. Symptoms can show up a few days before a tooth begins to sprout, and generally ease within a few days after the tooth appears.

What teething remedies should be avoided?

The FDA recommends avoiding benzocaine products—which includes many teething gels—for children under two years of age. These gels can sometimes cause a condition can methemoglobinemia, which can greatly reduce the amount of oxygen to a baby’s blood, resulting in serious medical conditions and sometimes even death. (5) While this condition is rare, it’s better to steer clear of teething gels all together.

Painkillers, while not as dangerous as teething gels, should be used extremely rarely. If baby is extremely uncomfortable and you decide to use them, be sure you choose a product developed specifically for children, and never exceed the recommended dosage.

Finally, while parents of yore often rubbed brandy or other liquors on their child’s gums to numb them, this isn’t safe.  Even the smallest amount of alcohol can be dangerous for a child.

How do I care for my baby’s new teeth?

Although your child won’t have his baby teeth, also known as primary teeth, forever, it’s important to care for them.

Your child should have first regular dental appointment after his first tooth comes in, or no later than one year old.

And since decay can occur as soon as teeth appear, it’s important to start caring for your child’s teeth as soon as they arrive. Initially, just wiping baby’s teeth with a washcloth will keep them clean. Be sure to do this after every feeding, and never send baby to bed with a bottle, as it can lead to baby bottle tooth decay.

As baby gets older and has more teeth, you may want to purchase a small, baby toothbrush with very soft bristles.

Then, before you know it, your child will have his first adult teeth, which should come in around 6-7 years of age. (6) While the process of gaining adult teeth can sometimes be uncomfortable as well, at this stage, you and your child can discuss the tooth eruption process.

Final thoughts on teething

If you’re reading this article, you’ve probably got a pretty fussy and difficult baby on your hands. Know that teething does pass and your baby will return to her normal self.

To summarize:

• Use a wooden teething toy and teething biscuits to satisfy baby’s desire to chew
• Stay away from teething medications and numbing gels
• Distract baby
• Get some help from a loved one to babysit. Dealing with a teething baby is hard work and you deserve a break, and a new person is a great distraction for baby!