BabyCroc
Chompy Doc, with a small stethoscope

Baby handbook

Teething

Health4 min read

When teeth usually show up, what teething can explain, and which medicines and necklaces to skip.

Teething gets blamed for everything from a bad night to a fever. Some of that blame is fair. A lot of it is not. Knowing the usual timeline, and the short list of symptoms that really do travel with erupting teeth, keeps you from missing an illness that needs a clinician.

When teeth arrive

The first teeth are usually the lower central incisors, often somewhere between 6 and 10 months. The upper centrals follow. First molars show up later, commonly in the second year, and they are the ones families remember as harder. A baby can be born with a tooth, which your pediatrician should see because a loose natal tooth is a choking risk. A baby can also reach the first birthday with a gummy smile and still be on a normal path. The order is more predictable than the date.

Rough timing Teeth
6 to 10 months Lower central incisors
8 to 12 months Upper central incisors
9 to 13 months Upper lateral incisors
10 to 16 months Lower lateral incisors
13 to 19 months First molars
16 to 23 months Canines
23 to 33 months Second molars

By age 3, most children have a full set of 20 primary teeth. If no tooth has appeared by 18 months, mention it at a visit. It is often still normal, and it is worth a look at growth and, occasionally, a dental referral.

What teething can feel like

For a few days around a tooth, many babies drool more, chew on everything, and are fussier, especially in the evening. Gums can look swollen and a little bluish where the tooth is pushing. A mild temperature can come with it. Appetite for solids may dip, while milk intake often holds.

What teething does not explain, according to the American Academy of Pediatrics, is a high fever, diarrhea that dehydrates, a rash that spreads, or a baby who is lethargic. Those are illness until a clinician says otherwise. A rectal or forehead temperature of 100.4°F (38°C) or higher in a baby under 3 months is an urgent call no matter what the gums look like. In an older baby, a fever that changes how they act is still a reason to call, even if a tooth is also on the way. Do not let “it’s just teething” delay that call.

Comfort that is actually safe

  • A clean finger rubbing the gum, if your baby likes the pressure
  • A firm rubber teether, chilled in the fridge, not frozen solid. A rock-hard frozen teether can hurt gums.
  • A clean wet washcloth to chew
  • Extra cuddles and an earlier bedtime for a few nights

If your baby is miserable and your pediatrician has already told you a pain medicine and a dose based on weight, use that plan. Do not borrow a dose from a friend’s baby or from a toddler chart. Do not use numbing gels that contain benzocaine. The U.S. Food and Drug Administration warns that benzocaine can cause a rare but serious blood disorder, methemoglobinemia, and should not be used in children under 2. Skip homeopathic teething tablets as well. Past products in that category have been linked to belladonna poisoning, and “natural” on the label is not a safety review.

Amber necklaces are a strangulation and choking hazard. The AAP does not recommend them. A bead that breaks off, or a necklace that catches, is not a fair trade for a theory about succinic acid. The same goes for any teething jewelry.

Teeth that are already here

Wipe the first teeth with a soft cloth or a baby toothbrush and a smear of fluoride toothpaste, about the size of a grain of rice, twice a day. The smear becomes a pea-sized amount around age 3. Fluoride is the reason baby teeth survive until the permanent ones arrive. Bottles in bed, and frequent sipping of anything but water, pool sugar on those new teeth. Milk at a meal or a feed is different from a bottle used as a pacifier all night.

The first dental visit is recommended by the first birthday, or within 6 months of the first tooth, whichever comes first. That visit is short. It is also where you can ask about fluoride varnish and your local water.

Logging the drool weeks

If sleep falls apart for three nights and a tooth appears on night four, the log will show you the pattern next time, and you will panic less. If sleep falls apart and no tooth appears, and your baby has fewer wet diapers or a real fever, the same log helps the clinician. Either way, the notes are more useful than a guess at 2 a.m.

Sources

This guide is general information for families, not medical advice, and it is not a substitute for your pediatrician.

This Baby handbook page is general information, not medical advice. When in doubt, call your pediatrician.