Babies in teething pain typically show a cluster of signs: increased drooling, chewing on anything they can get their hands on, red or swollen gums, fussiness, and disrupted sleep. Most babies start teething around 6 months of age, and the discomfort tends to come and go as each tooth pushes through. Knowing what’s normal teething behavior and what signals something more serious can save you a lot of worry.
The Most Reliable Signs of Teething Pain
The earliest and most consistent indicator is excessive drooling paired with a strong urge to chew or bite. You’ll notice your baby rubbing toys, fingers, or anything within reach against their gums. This isn’t random mouthing. It’s targeted pressure-seeking behavior that helps counteract the discomfort of a tooth pushing up through the gum tissue.
Crankiness is the other hallmark. A teething baby may cry more than usual, seem generally irritable, and have a harder time settling down. This fussiness often intensifies in the days just before a tooth breaks through the surface, then eases once it does. Some babies handle it with minimal complaint, while others are clearly miserable for several days at a stretch.
What the Gums Look Like
If you gently pull back your baby’s lip or run a clean finger along their gums, you may feel or see a hard bump where a tooth is about to emerge. The gum tissue in that spot is often red, swollen, and tender to the touch. In some cases, you’ll notice a bluish or gray bubble on the gum surface. This is called an eruption hematoma, a small pocket of fluid that forms as the tooth pushes upward. It looks alarming but usually resolves on its own once the tooth comes through.
Sleep and Feeding Changes
Teething pain doesn’t clock out at bedtime. Many parents first suspect teething when a baby who had been sleeping well suddenly starts waking more frequently at night or resisting naps. The discomfort tends to feel worse when your baby is lying down, with less distraction from the sensation.
Feeding disruptions are also common. Some babies refuse the breast or bottle because the sucking motion puts pressure on sore gums. Others want to nurse more often for comfort. You might also notice your baby pulling away mid-feed, fussing, then trying again. If appetite changes or feeding refusal persist for more than a few days, or your baby seems to be in more distress than typical teething would explain, it’s worth checking in with your pediatrician to rule out an ear infection or other issue.
Drool Rash Around the Mouth
All that extra saliva has a secondary effect. When drool sits on the skin around your baby’s mouth, chin, and neck, it can cause a red, bumpy, sometimes slightly raw-looking rash. This is purely a skin irritation issue, not an allergic reaction or infection.
To manage it, gently pat the area dry with a soft cloth throughout the day rather than rubbing, which can make the irritation worse. A thin layer of a barrier cream like Aquaphor or lanolin over the affected skin helps protect it from further moisture damage. Stick with mild, fragrance-free soap at bath time to avoid aggravating the rash further.
What Teething Does Not Cause
This is where a lot of parents get tripped up. Teething can nudge your baby’s body temperature slightly above normal, but it does not cause a true fever. A fever is defined as 100.4°F (38°C) or higher. If your baby hits that threshold or goes above it, something else is going on, likely an infection, and teething shouldn’t be blamed.
The same goes for diarrhea, vomiting, widespread body rashes, and unusual lethargy. These symptoms overlap with the teething window simply because babies between 6 and 24 months are constantly encountering new viruses. It’s easy to attribute everything to teething during that stretch, but doing so can delay recognition of a real illness. A 1975 editorial in the BMJ put it bluntly: there is no excuse for chalking up fever, seizures, diarrhea, or bronchitis to teething. That guidance still holds.
Which Teeth Hurt the Most
Teething typically begins around 6 months with the lower front teeth (central incisors), followed by the upper front teeth. These early eruptions often cause moderate fussiness. The teeth that tend to generate the most pain are the first molars, which come in around 13 to 19 months. Molars have a larger, flatter surface that has to push through more gum tissue, which means more swelling and pressure. Canines (the pointed teeth between the incisors and molars) can also be particularly uncomfortable because of their sharp shape.
Not every tooth will cause the same level of distress. You might see your baby sail through several eruptions with barely a whimper, then have a rough week when a molar finally comes in.
Safe Ways to Ease the Pain
The simplest and most effective relief is pressure on the gums. Rubbing your baby’s gums firmly with a clean finger gives direct counter-pressure against the emerging tooth. Most babies respond to this almost immediately, though some resist if the area is very tender.
Teething rings made of solid rubber or BPA-free silicone are the go-to recommendation. Look for one-piece designs that can’t break apart into smaller pieces. You can refrigerate these for a mild cooling effect, which helps reduce gum inflammation. Don’t freeze them. A frozen teething ring becomes too hard and can actually bruise or damage the gums. Liquid-filled teethers carry a risk of leaking, so solid options are safer. Silicone teethers with textured surfaces give babies something satisfying to gnaw on and can double as early toothbrushes.
For nights when the pain is clearly keeping your baby awake, age-appropriate doses of infant acetaminophen or ibuprofen (for babies 6 months and older) can help. Your pediatrician can confirm the right dose based on your baby’s weight.
Products to Avoid
The FDA has issued clear warnings against using topical numbing gels or creams containing benzocaine or lidocaine on infants’ gums. Products like Orajel, Anbesol, and similar over-the-counter gels fall into this category. Benzocaine can cause a rare but potentially fatal condition called methemoglobinemia, where red blood cells lose their ability to carry oxygen effectively. Prescription lidocaine solutions carry risks of seizures, serious brain injury, and heart problems in young children.
Homeopathic teething tablets are also on the FDA’s warning list. Despite being marketed as natural, some have been found to contain inconsistent levels of active ingredients, and the FDA has linked them to adverse events in children. These products offer little to no proven benefit and carry real risk. Stick with mechanical relief (chewing, pressure, cold) and, when needed, standard pain relievers approved for infants.