Baby Teething: Symptoms, Pain Relief, and What to Avoid

She's been chewing her fist since lunch. By 11 PM she's awake gnawing on her sleep sack, drool down her chin, fussy in a way that didn't exist three days ago. Her cheeks are flushed. You touch her forehead. Warm? Maybe? You spent two hours yesterday trying to remember if this is teething, or strep, or the start of a stomach bug.

Most of the time the answer is teething. But not all of the time, and the gap between the two is where most parents get tripped up.

When do baby teeth come in?

The first tooth usually breaks through between 6 and 10 months, almost always a bottom central incisor. By the first birthday most babies have 4 to 8 teeth. By age 3 the full set of 20 primary teeth is in.¹

There is a lot of variation. Some babies get their first tooth at 4 months. Others wait until after their first birthday with nothing wrong. As long as something is happening by 18 months, the pace doesn't matter clinically.

Tooth	Typical age
Lower central incisors	6-10 months
Upper central incisors	8-12 months
Upper lateral incisors	9-13 months
Lower lateral incisors	10-16 months
First molars	13-19 months
Canines	16-22 months
Second molars	23-33 months

The order matters less than parents expect. Skipping a tooth or getting the upper ones first happens, and it isn't a problem.¹

What teething actually feels like

A 2016 meta-analysis of 16 studies covering 3,506 children found symptoms during primary tooth eruption in about 70% of babies. The most common signs were:²

• Gum irritation: 87%
• Irritability: 68%
• Drooling: 56%

Add in the things that didn't make the top three but show up consistently: chewing on everything, slight loss of appetite, sleep disruption around the days a tooth actually breaks through, and a small rise in body temperature that stays below the fever threshold.

The drooling can be impressive. Some babies will soak through three bibs before lunch. It isn't a sign anything's wrong, just that the salivary glands are working overtime while the gums are inflamed.

What teething is NOT

This is the part that matters. The AAP and the same 2016 meta-analysis both find that teething does not cause:²³

• High fever (anything 100.4°F / 38°C or above is not teething, it's something else)
• Diarrhea
• Vomiting
• Rashes other than mild drool irritation on chin and cheeks
• Cough or congestion
• Lethargy

Teeth start coming in around 6 months, the same time maternal antibodies wane and babies start putting everything in their mouth. That's why teething and minor illness so often overlap on the calendar. The mistake parents make (and pediatricians sometimes endorse) is blaming a real fever on teething and waiting to call. A 2000 Pediatrics study following 125 babies prospectively found no correlation between tooth eruption and high fever, ear pulling, sleep problems, or any of the symptoms parents most commonly attribute to teething.⁴

The clinical implication is direct: if your baby has a fever above 100.4°F, treat it as a fever, not as teething. The AAP explicitly warns that attributing fever to teething can delay diagnosis of ear infections, urinary tract infections, and meningitis.³

What actually helps

The boring options are also the best ones.

Counter-pressure on the gums. Babies want to chew on something firm. A clean finger rubbed against the swollen spot works. A solid silicone or rubber teether works. The chewing pressure is doing the relief, not any cooling.

A chilled, not frozen, teether or wet washcloth. Cold is mildly numbing. Frozen is too hard, and it can bruise the gums and make things worse. Twist a wet washcloth, put it in the fridge for 30 minutes, hand it over.

Distraction. Sounds dismissive, but it isn't. Pain that has your attention always feels bigger. A walk outside, a new toy, a different room. These don't fix the gum, they just lower the volume.

Pediatric acetaminophen (Tylenol) at the weight-based dose, if your baby is over 2 months and the discomfort is genuinely interfering with sleep. The AAP supports this for a hard night, not as a routine.³

That's the whole list of things with evidence behind them. Wooden rings, mesh feeders with frozen fruit, the back of a cold spoon: all fine if your baby likes them, none necessary.

What to skip entirely

Three categories have explicit safety warnings and shouldn't be used at all.

Benzocaine gels and creams (Orajel, Anbesol, Baby Orajel, store-brand teething gels). The FDA issued a formal warning on May 23, 2018 against using any oral benzocaine product on children under 2.⁵ The risk is methemoglobinemia, a blood disorder where oxygen stops moving through the body efficiently. About 400 cases have been documented, and some were fatal. The FDA asked manufacturers to stop selling teething-marketed benzocaine products and required a contraindication on what stayed on shelves.

Homeopathic teething tablets and gels. In January 2017, the FDA found inconsistent and sometimes dangerous amounts of belladonna (deadly nightshade) in Hyland's homeopathic teething tablets.⁶ A nationwide recall followed in April 2017. Over the prior decade the FDA had received reports of 10 deaths and hundreds of adverse events, including seizures and vomiting, in infants given homeopathic teething products. The warning still stands: don't use any homeopathic teething tablet, even if the package looks gentle.

Amber, silicone, or wooden teething necklaces and bracelets. The FDA issued a warning in December 2018 after a documented strangulation death of an 18-month-old wearing one during a nap, plus reports of beads breaking off and causing choking.⁷ There is no clinical mechanism by which a necklace can deliver a numbing or pain-relieving effect. The AAP recommends no jewelry on infants for any reason.

If a relative gave you one already, the safest place for it is a drawer.

When it's probably not teething

Call the pediatrician if any of these show up:

• Temperature 100.4°F (38°C) or higher rectally, especially in a baby under 3 months
• Pulling at one ear and crying, or fluid coming from the ear (likely ear infection)
• Persistent diarrhea or vomiting
• Rash beyond mild drool irritation
• Lethargy or hard to rouse
• Refusal to feed across several feeds
• Symptoms that last more than 3 to 5 days without a tooth appearing

The pattern with teething is days, not weeks. A baby who has been "teething" for two weeks straight with no tooth visible probably has something else going on.

How to track it without overthinking

Log the first tooth in nappi's Milestones when it breaks through. The date is genuinely useful at the dentist's first visit (the AAPD recommends one within six months of the first tooth, no later than the first birthday). Beyond that first one, tracking every individual tooth gets old fast and adds no real information. For sleep patterns around teething, our teething and sleep guide covers what to expect.

If teething is disrupting sleep, the nappi sleep tracker will show the dip alongside your baby's normal patterns. A typical eruption causes a few rough days, then sleep normalizes. If sleep stays bad for two weeks without recovery, the 4-month sleep regression or 8-month sleep regression is a more likely culprit than continuous teething.

Frequently asked questions

Can teething cause a fever?

Not by the medical definition. Teething can raise a baby's temperature by a fraction of a degree, but a true fever (100.4°F / 38°C or higher) is from something else. The 2016 Pediatrics meta-analysis found temperature rises during eruption that stayed below the fever threshold.² Treat anything above 100.4°F as a fever and call the pediatrician, especially under 3 months old.

How long does teething pain last per tooth?

Active discomfort tends to last 3 to 5 days around when the tooth actually breaks through the gum. Some babies have a longer warm-up stretch of chewing and drooling before that. If your baby has been miserable for more than a week without a tooth appearing, the source is probably not teething.

Do molars hurt more than incisors?

Many parents report worse stretches when the first molars come in (around 13 to 19 months). The teeth are bigger and the eruption surface is wider. The principles don't change: counter-pressure, chilled (not frozen) teether, acetaminophen if it's interfering with sleep. The duration per tooth is similar.

My baby has been teething for months. Is that possible?

Sort of. The eruption process happens in waves with quiet weeks in between. What's unlikely is months of continuous severe symptoms. That pattern usually means something else (a chronic ear infection, a sleep regression, or a feeding issue) is being labeled as teething. If symptoms feel constant rather than wave-like, mention it at the next well-baby check.