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Posted by Dr. Monica Wonnacott | January 23, 2016

What To Do About Teething

Thanks S.P. from Utah for your recent topic suggestion on teething.

I hear a lot of myth and misconception about teething. At least once a week I hear parents blame signs and symptoms of true illness on teething. So here’s the real scoop on teething.

When does teething happen?

Most infants have their first tooth appear somewhere between 6-8 months. However, it is considered normal anywhere between 4-14 months. All of the primary teeth (first set or baby teeth) should be in by 2 1/2. As an aside, most secondary (permanent teeth) start coming in between 6-8 years.

What are the signs and symptoms of teething?

  • Gum sensitivity and swelling. This is the best predictor (in my opinion). If you take a look at your infant’s gum line and it is red and swollen/boggy, your infant is probably teething. If the gum line is light pink and still firm (or hard) than it is likely not teething. If you aren’t certain, compare the top and the bottom gums. A big difference suggests teething (usually the bottom teeth come in first).
  • Drooling. Drooling is a tricky symptom. A lot of babies will drool for months before they ever cut their first tooth. It’s not the tell-tale sign that everyone thinks. A big change in how much your child is drooling can be a sign.
  • Irritability. Presumably, this is from the pain caused by pressure on the gums from the erupting tooth.
  • Poor sleep.
  • Refusing food.
  • Need to chew on hard objects. Remember that at around 4 months, many infants start to put everything in their mouth (including their hands) as a normal developmental milestone.
  • (Possibly) low grade fever. Here’s the scoop on fever. The American Academy of Pediatrics states that fever greater than 101 Fahrenheit (38.3 degrees Celsius) is NOT usually due to teething. Keep in mind that fever is defined as temperature greater than 100.4. If you do the math, that’s only 0.6 degrees of an increase that can be attributable to teething. Teething is a normal part of growth, it shouldn’t make a child ill.

What to do about teething?

If your baby is seems uncomfortable when teething you can try:

  • Gently rubbing or massaging the gums with your fingers.
  • Teething toys (usually made of firm rubber). Be cautious that they don’t have pieces or parts that can your baby can bite off. While cold is good (it can be soothing), the toys designed to freeze often make the toy rock hard and difficult for the infant to chew.
  • Medications. Tylenol or Motrin can help ease your baby’s pain. Make sure and dose appropriately based on weight. Medications that are rubbed directly on the gums should be used with caution. They can be harmful if your baby swallows a lot. Also they tend to wash out of a baby’s mouth very quickly.
  • Home remedy. A helpful tip a colleague shared with me when my baby was teething was placing a clean, damp washcloth in the freezer for a few minutes and then letting your baby chew on it. The cool temperature, soft/slight crunch (from the freezer), and texture of the washcloth are all soothing/relieving to an infant. My baby responded well to it; give it a try.

Is it teething or an ear infection?

I regularly get parents who bring patients in with a high fever, runny nose, and irritability. Often times the parents think (or thought initially) that symptoms are due to teething. More often than not, it’s an ear infection. Bottom line, if your child looks ill, it probably isn’t teething and warrants being seen by a pediatrician.