Teething & Sleep Guide

Does teething really disrupt sleep?

This is one of the most debated topics in pediatrics, and the honest answer is: probably less than you think.

A 2025 landmark study by Tsang et al. in the Journal of Pediatrics followed 849 babies using objective sleep measurements (actigraphy) and found no measurable sleep disruption during teething episodes, even though parents consistently reported their baby was sleeping worse. The researchers concluded that parental perception of teething sleep problems may be shaped by confirmation bias: when a tooth appears, any recent fussiness gets attributed to it.

An earlier study by Macknin et al. (2000, Pediatrics) did find a mild association between teething symptoms and sleep disruption, but only in an 8-day window around eruption, and the effects were small. A 2016 meta-analysis by Massignan et al. confirmed that symptoms like gum irritation, irritability, and drooling are real but generally mild and self-limited.

Bottom line: teething symptoms are real, but mild and brief. If your baby has significant sleep disruption lasting more than a week, teething is probably not the main cause. Look at sleep habits, illness, or developmental changes.

Tooth eruption timeline

Babies typically cut their first tooth around 6 months, though the range is wide (4-15 months is normal). Here's when each type of tooth usually shows up:

These ranges are averages. Some babies cut teeth earlier or later, and the order can vary. Late teething is almost never a cause for concern. Check in with your pediatrician if no teeth have appeared by 18 months.

Teething symptoms vs. illness

Many symptoms get misattributed to teething. Knowing the difference helps you respond appropriately and recognize when your baby needs medical care.

Always call your doctor for a fever above 38°C (100.4°F), especially in babies under 3 months. Teething does not cause high fever, diarrhea, or vomiting; these signal illness and should not be dismissed as "just teething."

What actually works

Not every teething remedy is equal. Here's what the evidence shows:

Safe and effective

• Chilled teethers: The most effective remedy per Memarpour et al. (2015). Chill them in the fridge, not the freezer; frozen objects can hurt the gums. Solid silicone teethers are the safest.
• Gum massage: Gently rub the gums with a clean finger or a cool, damp cloth. Counter-pressure on irritated gums provides real relief.
• Acetaminophen (Tylenol): Safe for babies 3 months and older. Use the weight-based dose. Effective for pain and mild fever. Check with your pediatrician for the right dose.
• Ibuprofen (Advil/Motrin): Safe for babies 6 months and older. Better anti-inflammatory effect than acetaminophen, which makes it especially helpful for gum swelling. Don't give to babies under 6 months.

What to AVOID

• Benzocaine gels (Orajel, Anbesol): The FDA has warned against benzocaine use in children under 2. It can cause methemoglobinemia, a rare but potentially fatal condition that lowers blood oxygen levels.
• Amber teething necklaces: There is no scientific evidence they work. The FDA issued a safety warning in 2018 after reports of strangulation, choking, and mouth injuries. The claim that succinic acid from amber relieves pain has never been demonstrated in any study.
• Homeopathic teething tablets/gels: The FDA issued warnings after lab testing found inconsistent levels of belladonna (a toxic substance) in some products. Multiple adverse-event reports, including seizures and deaths, have been linked to these products.

How to handle sleep during teething

The most important thing you can do: keep your routine consistent. Teething discomfort is temporary (usually 3-8 days per tooth), but the sleep habits that form during that stretch can last months.

• Keep your bedtime routine: Bath, book, feed, bed — whatever your routine is, keep doing it. Consistency tells your baby it's time to sleep, even when they're uncomfortable.
• Don't build new sleep associations: It's tempting to rock, nurse, or bed-share through teething. But if your baby wasn't doing that before, starting now creates a new habit you'll have to undo later.
• Offer relief before sleep: Give a chilled teether 15-20 minutes before bed. If your pediatrician has cleared it, a dose of pain reliever before bed can help them settle.
• Brief visits for night wakings: If your baby wakes, go in and offer brief comfort. Pat, shush, offer the teether — but try not to pick them up if they can settle with less intervention.
• Remember: it's temporary: Each tooth takes 3-8 days. The worst is usually the 2-3 days before the tooth breaks through the gum. Molars (around 13-19 months) tend to cause more discomfort than incisors because of their larger surface area.