Teething & Sleep Guide

Does teething actually disrupt sleep?

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

A landmark 2025 study by Tsang et al. in the Journal of Pediatrics tracked 849 infants using objective sleep measures (actigraphy) and found NO measurable sleep disruption during teething episodes — even though parents consistently reported that their baby slept worse. The researchers concluded that parental perception of teething-related sleep problems may be driven by confirmation bias: when parents see a tooth, they attribute any recent fussiness to it.

An earlier study by Macknin et al. (2000, Pediatrics) did find a mild association between teething symptoms and sleep disruption, but only within an 8-day window around tooth 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-limiting.

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

Tooth eruption timeline

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

These ranges are averages. Some babies get teeth earlier or later, and the order can vary. Late teething is almost never a concern — talk to your pediatrician if no teeth have appeared by 18 months.

Teething symptoms vs. illness

Many symptoms are incorrectly blamed on teething. Knowing the difference helps you respond appropriately — and recognize when your baby needs medical attention.

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

What actually helps

Not all teething remedies are equal. Here's what the evidence says:

Safe and effective

• Chilled teething rings — The most effective remedy according to Memarpour et al. (2015). Chill in the refrigerator, not the freezer — frozen objects can hurt gums. Solid silicone rings are safest.
• Gum massage — Gently rub the gums with a clean finger or a damp, cool washcloth. Counter-pressure on sore gums provides relief.
• Acetaminophen (Tylenol) — Safe for babies 3+ months. Use weight-based dosing. Effective for pain and mild temperature. Ask your pediatrician for the right dose.
• Ibuprofen (Advil/Motrin) — Safe for babies 6+ months. Better anti-inflammatory effect than acetaminophen, making it particularly effective for gum inflammation. Do not give to babies under 6 months.

What to AVOID

• Benzocaine gels (Orajel, Anbesol) — The FDA has warned against using benzocaine in children under 2. It can cause methemoglobinemia, a rare but potentially fatal condition that reduces blood oxygen levels.
• Amber teething necklaces — 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 tests 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.

Managing sleep during teething

The single most important thing you can do: keep your routine consistent. Teething discomfort is temporary — typically 3-8 days per tooth — but sleep habits formed during that time can last months.

• Maintain your bedtime routine — Bath, book, feed, bed — whatever your routine is, keep doing it. Consistency signals to your baby that it's time to sleep, even when they're uncomfortable.
• Don't create new sleep associations — It's tempting to rock, nurse, or co-sleep to get through teething. But if your baby wasn't doing these before, starting now creates a new habit you'll need to break after teething passes.
• Offer relief before bed — Give a chilled teething ring 15-20 minutes before bedtime. If your pediatrician has approved it, a dose of pain relief before bed can help your baby settle.
• Brief check-ins for night waking — If your baby wakes, go in and offer comfort briefly. Pat, soothe, offer the teething ring — but try to avoid picking 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. Molars (around 13-19 months) tend to cause more discomfort than incisors because of their larger surface area.