Baby Teething: Symptoms, Chart and What Actually Helps

Quick answer

Most babies get their first tooth between 4 and 10 months, usually around 6 months. Teething causes drooling, gum rubbing, irritability and disturbed sleep. It does not cause fever, diarrhoea, vomiting or a rash on the body. If your baby has those, they are unwell with something else and need to be assessed. Cold, firm teethers and gum pressure help. Gels, necklaces and traditional gum remedies do not.

Key takeaways

• Teething does not cause fever. Attributing a fever to teething is the most common and most consequential mistake, because it delays assessment of an actual illness.

• Never put anything around a baby's neck or wrist for teething. Amber necklaces and thread bracelets carry strangulation and choking risks and have no proven benefit.

• Avoid teething gels containing benzocaine or lidocaine in babies. Regulators have warned against them.

• Chill teethers in the fridge, never the freezer. A frozen teether is hard enough to damage gums.

• Start brushing as soon as the first tooth appears, twice a day, with a fluoride toothpaste in a rice-grain smear.

When do babies start teething?

Most babies get their first tooth somewhere between 4 and 10 months, with 6 months being the most common. Some get one at 3 months, some not until after their first birthday.

Late teething is usually normal. If there is no tooth by around 18 months, mention it to your paediatrician or a paediatric dentist, but before that it is almost always just variation.

Occasionally a baby is born with a tooth, or one appears in the first weeks. This is called a natal or neonatal tooth. Show it to your paediatrician, since some are loose and need removing while others are left alone.

Tooth eruption chart

Teeth usually come in pairs, and the lower front two are typically first.

All 20 baby teeth are usually through by around 2 and a half to 3 years.

Considerable variation is normal. What matters is steady progress rather than matching the chart exactly.

Teething symptoms

What teething does cause:

• Drooling, sometimes a lot

• Chewing and gnawing on hands, toys and anything else

• Rubbing the gums, cheeks or ears on the same side

• Swollen, red or tender gums

• Irritability and fussiness, usually for a few days around each tooth

• Disturbed sleep

• Reduced appetite, or refusing the breast or bottle briefly

• A mild rash or chapping around the mouth and chin from the drool

Sometimes a small bluish swelling appears over an emerging tooth. This is an eruption cyst, it is harmless, and it usually resolves on its own.

What teething does NOT cause

This is the most important section on the page.

Teething does not cause:

• Fever. Teething may be associated with a very slight rise in temperature, but not a fever

• Diarrhoea

• Vomiting

• Cough or runny nose

• A rash on the body

• Prolonged loss of appetite

• Convulsions

If your baby has any of these, they are unwell with something else.

Why this matters more than it sounds: babies start teething at around six months, which is exactly when the antibodies passed from their mother are fading and they begin getting infections. The timing overlaps, which is why the two get confused. Attributing a fever to teething is one of the commonest reasons a sick baby is not brought in.

Any fever in a baby under 3 months is an emergency, whatever else is happening.

What actually helps

What to avoid

Oral care from the first tooth

Most teething articles stop at remedies, but this is what prevents problems later.

• Before teeth: wipe the gums with a clean damp cloth once a day

• From the first tooth: brush twice a day with a soft baby toothbrush

• Use fluoride toothpaste. A rice-grain sized smear under 3 years, and a pea-sized amount from 3 to 6 years

• Brush the last thing at night, and do not rinse with water afterwards. Spit out only

• You do the brushing until your child is around 7 or 8. They can have a turn first, but you finish

• Do not put your baby to bed with a bottle of milk or juice. Milk pooling around the teeth overnight is the main cause of early childhood tooth decay, which is very common in India

• Move to a cup from around 12 months where possible

• No sweetened water, juice in a bottle, or sugar on a dummy

If you live in an area with naturally high fluoride in the water, which occurs in parts of India, ask your dentist about the right toothpaste for your child. Do not simply stop fluoride, since it protects against decay.

When to see a doctor or dentist

See a doctor the same day if your baby has:

• Any fever in a baby under 3 months

• Fever with drowsiness, poor feeding or a rash

• Diarrhoea or vomiting, particularly with fewer wet nappies

• Refusing all feeds

• Fast or laboured breathing

• Unusual drowsiness or floppiness

• Swelling of the face or jaw, or a hot tender area on the gum, which may indicate infection

Do not assume any of these is teething.

See a paediatric dentist if:

• Your child has reached their first birthday. The recommendation is a first dental visit by age one, or within six months of the first tooth appearing, whichever comes first

• No teeth have appeared by around 18 months

• A tooth appears discoloured, brown, or with white spots or pitting

• Teeth are chipped or damaged after a fall

• Your baby was born with a tooth, or one appeared in the first weeks

• The gums bleed easily or look swollen beyond the erupting tooth

Frequently asked questions

Does teething cause fever?
No. Teething may cause a very slight rise in temperature but not a fever. A fever means your baby is unwell with something else and should be assessed.

Does teething cause diarrhoea?
No. Diarrhoea in a teething baby is a separate illness and needs attention, particularly if wet nappies reduce.

When do babies start teething?
Usually between 4 and 10 months, most commonly around 6. Some start earlier and some after their first birthday.

My baby is 12 months and has no teeth. Is that a problem?
Usually not. Mention it at your next visit, and see a paediatric dentist if there are still no teeth by around 18 months.

Are amber teething necklaces safe?
No. They carry strangulation and choking risks and have no proven benefit. Nothing should be worn around a baby's neck or wrist.

Can I use a teething gel?
Avoid gels containing benzocaine or lidocaine in babies, as regulators have warned against them. Ask your paediatrician before using any gel or medication.

Should I freeze the teether?
No. Chill it in the fridge for 15 to 20 minutes. A frozen teether is hard enough to damage your baby's gums.

Can I rub honey or brandy on the gums?
No. Honey is unsafe under 12 months because of infant botulism risk, and alcohol is toxic to infants. Neither should be used.

When should I start brushing my baby's teeth?
As soon as the first tooth appears. Twice a day, with a rice-grain smear of fluoride toothpaste.

When is the first dental visit?
By your child's first birthday, or within six months of the first tooth appearing, whichever comes first.

The bottom line

Teething is uncomfortable rather than dangerous, and the things that help are simple: firm gum pressure, a chilled solid teether, a cold washcloth and extra comfort. Skip the gels, the necklaces and the traditional gum remedies, none of which help and several of which carry real risk. And hold on to one rule above all: teething does not cause fever, diarrhoea or vomiting, so if your baby has any of those, they need to be seen rather than soothed.

Sources

• American Academy of Pediatrics, teething and dental care for babies

• US Food and Drug Administration, safely soothing teething pain in infants and children

• NHS, baby teething symptoms and tips

• American Academy of Pediatric Dentistry, policy on the dental home and first visit

• World Health Organization, oral health

• Indian Academy of Pediatrics, infant and child health guidance

• Indian Society of Pedodontics and Preventive Dentistry, guidance on early childhood caries and fluoride use

This article is for general information and is not a substitute for professional medical advice. Never attribute fever, diarrhoea or vomiting to teething. Seek care the same day for any fever in a baby under three months.