Baby Teething: Symptoms, Timeline, and How to Help

Teething is the explanation parents reach for whenever a baby is unsettled and there is no obvious other cause — and a lot of the time it is wrong. Real teething is unpleasant for a few days around an emerging tooth. It does not cause high fever, severe diarrhoea, vomiting, or weeks of misery. Knowing the difference saves you from missing a treatable illness, and saves you from buying things that don't work or aren't safe.

Logging tooth eruption dates in Healthbooq gives you a real reference for whether the next bad night is plausibly a tooth or whether something else is going on.

When Teeth Actually Arrive

The textbook number is "around 6 months" but the real range is much wider. Useful framing:

• First tooth: typically 4–10 months. The range is 3 months to 13 months and all of that is normal.
• Lower central incisors first (the bottom two front teeth), usually together or within a few weeks of each other.
• Upper central incisors next, around 8–12 months.
• Lateral incisors (next to centre) — 9–13 months.
• First molars — 13–19 months. These are the painful ones for many babies.
• Canines — 16–22 months.
• Second molars — 23–33 months. Final ones.

By around 2.5–3 years the full set of 20 primary teeth is in. Late starters who get their first tooth at 12 or 13 months catch up — there is no late-eruption disadvantage.

If no teeth by 13 months, mention it to the GP or dentist. Late eruption is usually just genetics but rarely indicates an underlying condition.

What Teething Genuinely Causes

The symptoms backed by research (notably the Macknin et al. and Wake et al. studies):

• Drooling. The most consistent sign.
• Chewing on everything. The chewing pressure relieves the gum sensation.
• Gum redness or visible swelling at the eruption site. You can sometimes see or feel a hard ridge a few days before the tooth breaks through.
• Irritability. Real but not severe.
• Sleep disturbance. Mild and short-lived around the actual eruption.
• Mild raised temperature, but under 38°C. A small inflammatory response. Actual fever is something else.
• Slight loose stool sometimes — possibly from extra saliva swallowed. Persistent diarrhoea is not teething.

Symptoms tend to cluster in the 3–5 days around an emerging tooth, not for weeks.

What Teething Does NOT Cause

This is the part that matters because misattribution leads to missed illness.

• Fever above 38°C. That is illness — viral, ear infection, urine infection. Investigate.
• Persistent diarrhoea (more than a day or two of multiple watery stools). That is gastroenteritis or another cause. Watch hydration.
• Significant vomiting. Same — illness, not teeth.
• Runny nose, cough, or chest symptoms. Coincidence — babies aged 6–24 months have an average of 8–12 viral infections a year, and they are constantly teething. Overlap is normal.
• Severe ear pain. Could be otitis media. Check with GP.
• A red rash other than the wet drool patches around the chin/neck (which is irritation from saliva).
• Loss of appetite for solids over multiple days. Investigate.

The 1996 review by Wake, Hesketh, and colleagues, and a 2016 systematic review by Massignan et al., both concluded that teething is associated with mild local symptoms but not with significant systemic illness. Treating a fever as "just teething" is one of the more common reasons illness is caught late.

A simple rule: if your baby has a fever 38°C or higher, do not write it off as a tooth. If your baby is not themselves for more than a couple of days, see a GP. Teeth do not make a baby ill.

What Helps

Counter-pressure on the gum is the most effective thing — it dampens the nerve signal from the eruption site.

• Chilled (not frozen) teething ring. Pop a silicone teether in the fridge for 30 minutes. Frozen teethers are too hard and can damage gum tissue.
• Clean finger gum massage. Wash hands, rub the swollen ridge with firm gentle pressure for a minute or two.
• A wet flannel chilled in the fridge — works as well as anything bought.
• A cold piece of cucumber or banana (over 6 months only, supervised) — relieves and feeds at once.
• Distraction. A change of room, a walk, a different toy. Pain perception drops with attention shift.

• Paracetamol (Calpol equivalent) — from 2 months at the appropriate weight-based dose. 2.5ml (120mg) infant suspension is the typical dose for a 4–6 month old; check the bottle for your baby's weight.
• Ibuprofen — from 3 months and at least 5kg. 2.5ml infant suspension is typical for 3–6 months. Give with or after food.
• Use sparingly — for an evening or two around an emerging tooth. Not as a routine bedtime aid.

What Not to Use

Amber teething necklaces. Marketed with claims of analgesic succinic acid release through the skin — there is no evidence the acid is released, no evidence it would have an analgesic effect if it were, and real evidence of strangulation and choking deaths. The Lullaby Trust, US FDA, and the Australian Competition and Consumer Commission all warn against them. The FDA recorded one death in 2016. Do not use.

Benzocaine gels (Bonjela Teething Gel was reformulated in the UK; some imports still contain benzocaine; in the US: Anbesol, Orajel, etc.). The FDA issued a 2018 warning against benzocaine for under-2s because of the risk of methaemoglobinaemia — a potentially fatal blood disorder. The MHRA in the UK has similar concerns. Do not use products containing benzocaine on under-2s.

Lidocaine gels. EU and UK regulators withdrew most lidocaine-containing teething products in 2018. Lidocaine can numb the throat, suppress the gag reflex, and cause aspiration. Avoid.

Sugary "teething" syrups of any kind. Even sugar-free ones rarely have evidence of efficacy. Sugary ones cause early tooth decay on the teeth that just came through.

Homeopathic teething tablets. The US FDA recalled multiple homeopathic teething tablets in 2017 after reports of seizures linked to inconsistent belladonna concentrations. Not worth the risk.

Rubbing whisky/brandy on gums. A folk remedy that puts alcohol into a small, low-weight body. Do not.

Care of the First Tooth

Start brushing the day the first tooth appears.

• A smear (rice-grain-sized) of fluoride toothpaste containing at least 1,000ppm fluoride for under-3s. The NHS guidance is clear — fluoride matters from the first tooth.
• A small soft baby toothbrush.
• Twice daily — last thing at night and at one other time.
• The child sits in your lap or you sit behind them; tilt the head slightly back, brush in small circles, do not rinse with water afterwards (spit only — leaves fluoride residue).
• From age 3, a pea-sized blob.
• First dental check: by 1 year, or within 6 months of the first tooth — covered by NHS dentistry.

Early childhood caries (decay in the first teeth) is preventable with this routine. Bottle propping, sugary drinks (including fruit juice) in a bottle, and dummies dipped in honey or sugar are the main causes — avoid them.

When to Call the GP

• Fever 38°C or higher (any age) — do not assume teeth.
• Fever 38°C+ in a baby under 3 months — same day call to GP / NHS 111 always.
• Persistent diarrhoea or vomiting.
• Refusing all feeds or fluids for more than a few hours.
• Floppiness, unusual lethargy, or a non-blanching rash — emergency.
• A tooth coming in at an obviously wrong angle, or eruption with bleeding that does not stop.

First teeth typically arrive between 4 and 10 months — not 6 — with normal range from 3 to 13 months. Real teething symptoms: drool, chewing, gum redness, irritability, mild raised temperature under 38°C. Teething does NOT cause high fever, persistent diarrhoea, vomiting, or runny nose — those are illness, look for the real cause. What helps: a chilled (not frozen) silicone teether, clean finger gum massage, weight-appropriate paracetamol or ibuprofen for genuine distress. Avoid: amber teething necklaces (FDA and Lullaby Trust warn — strangulation, choking, no evidence), benzocaine gels (FDA warning under 2 — methaemoglobinaemia risk).