The earliest signs that your baby is teething are usually increased drooling and swollen, tender gums where a tooth is pushing through. Most babies start teething around 6 months old, though it can begin as early as 4 months or as late as 12. Symptoms tend to appear about four days before a tooth breaks the surface and can linger for about three days afterward, so each tooth brings roughly a week of discomfort.
The Most Reliable Signs of Teething
The clearest physical sign is a change in your baby’s gums. The area where a tooth is about to emerge will look red and swollen, and the tissue will feel puffy or firm if you gently run a clean finger along it. You may eventually see or feel a hard white edge just beneath the surface before the tooth fully breaks through.
Drooling is often the first thing parents notice, sometimes weeks before a tooth appears. The extra saliva is part of the body’s response to gum irritation. Along with the drooling, you’ll typically see a cluster of behavioral changes:
- Chewing or biting on objects. Babies press things against their gums because counterpressure helps relieve the aching sensation.
- Fussiness and irritability. The discomfort is intermittent, so your baby may seem fine one hour and cranky the next.
- Difficulty sleeping. More than 80% of teething infants and toddlers experience sleep disruptions, according to research reviewed by the Sleep Foundation. Night wakings increase because there’s less distraction from the pain at night.
- Reduced appetite. Sucking on a bottle or breast can intensify gum pressure, so some babies pull away during feeds or eat less than usual. They may also prefer softer, easier-to-eat foods over anything that requires chewing.
- Mild ear pulling. Pain from the gums can radiate along the jaw to the ear area, so babies sometimes tug at the ear on the same side as the erupting tooth.
Why Teething Hurts
A tooth doesn’t simply slide out of the gum. Beneath the surface, specialized cells gradually dissolve the bone above the developing tooth while other cells build bone below it, creating upward pressure. As the tooth pushes closer to the surface, it compresses the gum tissue, triggering the release of inflammatory molecules. These are the same chemicals your body produces during any minor injury, which is why the gums swell, redden, and become tender. The inflammation is temporary and resolves on its own once the tooth clears the tissue.
Drool Rash: A Secondary Sign
All that extra drool can irritate the skin around your baby’s mouth, chin, and neck. A drool rash shows up as red, slightly raised patches that may look dry or chapped, sometimes with small bumps. It’s not harmful, but it can add to your baby’s discomfort. Keeping the area dry by gently patting away drool throughout the day and applying a thin layer of petroleum jelly as a moisture barrier helps prevent it.
What Teething Does Not Cause
One of the most important things to know is what teething is not responsible for. Teething does not cause a true fever. It may raise your baby’s temperature very slightly, but it should stay below 100.4°F. A temperature above 101°F points to something else, most likely a viral infection. The timing is coincidental: babies begin teething right around the age when the antibodies they received from their mother start to wane, making them more susceptible to common illnesses.
Diarrhea, a runny nose, and a persistent cough are also not teething symptoms. If your baby has any combination of those, treat it as you would a regular illness rather than chalking it up to a new tooth.
Teething vs. Ear Infection
Because teething babies sometimes pull at their ears, it’s easy to worry about an ear infection. A few differences help you tell them apart. Teething-related ear pulling is usually mild and one-sided, matching the side where a tooth is coming in. Ear infection pulling tends to be more persistent and may involve both ears. Ear infections also typically follow a cold and come with a fever above 100.4°F, cold symptoms like cough or congestion, and sometimes fluid or pus draining from the ear. None of those are features of teething.
Safe Ways to Ease the Discomfort
The simplest relief is pressure on the gums. A clean, chilled (not frozen) teething ring or a cold, damp washcloth gives your baby something safe to bite. You can also gently massage the swollen gum area with a clean finger. For babies eating solids, chilled soft foods like cold applesauce or yogurt can soothe from the inside.
What you should avoid matters just as much. The FDA has issued clear warnings against using numbing gels or creams containing benzocaine or lidocaine on infants’ gums. Benzocaine can cause a dangerous condition that severely reduces the blood’s ability to carry oxygen. Lidocaine solutions carry risks of seizures, heart problems, and brain injury in young children if too much is applied or accidentally swallowed. Homeopathic teething tablets have also been flagged by the FDA as potentially harmful. These products offer little to no measurable benefit for teething pain, and the risks far outweigh any perceived relief.
The Tooth Eruption Timeline
Knowing which teeth come in when can help you anticipate the next round of symptoms. The lower front teeth (central incisors) are almost always first, typically between 6 and 10 months. The upper front teeth follow shortly after, usually between 8 and 12 months. From there, the lateral incisors fill in on either side, followed by the first molars around 12 to 16 months. Canines (the pointed teeth between the incisors and molars) arrive between 16 and 20 months, and the second molars come in last, between 20 and 30 months.
Molars tend to cause more discomfort than incisors because of their larger surface area pushing through the gums. So even if your baby breezed through the front teeth, the molars may bring a noticeably rougher stretch. By around age 3, most children have their full set of 20 primary teeth, and the on-and-off teething cycle is finally over.
Sleep Disruptions During Teething
Broken sleep is one of the most exhausting parts of teething for the whole family. Because gum pain flares when there’s nothing else competing for your baby’s attention, nighttime tends to be the hardest. You may find your baby waking more frequently or having trouble settling down at bedtime. The instinct is to introduce new soothing routines, but offering too many new sleep interventions during teething can create habits that stick around long after the tooth is through. A chilled teething ring before bed and a brief, calm response to night wakings usually keeps things manageable without disrupting established sleep patterns. The worst of it typically passes within a few days of the tooth breaking the surface.