Most babies start teething between 4 and 7 months old, and the signs are usually a cluster of behaviors rather than one single symptom. The classic combination is increased drooling, swollen gums, and a baby who suddenly wants to chew on everything in sight. If you’re noticing these together, teething is the likely explanation.
The Most Reliable Signs of Teething
Drooling is typically the first thing parents notice, sometimes weeks before a tooth actually appears. Your baby may soak through bibs faster than usual, and you might see a mild rash on their chin or cheeks from the constant moisture. Around the same time, their gums will look red, swollen, and puffy in the spot where a tooth is pushing through.
The other signs tend to follow quickly:
- Chewing or biting on objects. Babies press hard things against their gums because the counter-pressure relieves discomfort. Fingers, toys, the edge of a crib rail: anything they can get into their mouth becomes a target.
- Fussiness and irritability. The discomfort is intermittent, so your baby may seem fine one hour and cranky the next. This on-and-off pattern is typical of teething rather than illness.
- Difficulty sleeping. Gum pain often flares at night when there are fewer distractions, so a baby who was previously sleeping well may start waking more frequently.
- Loss of appetite. Sucking on a bottle or breast can increase pressure on inflamed gums, so some babies pull away during feeds or refuse solids they normally enjoy.
Not every baby gets all of these symptoms. Some breeze through teething with little more than extra drool, while others are noticeably uncomfortable for several days before each tooth breaks through.
What the Gums Actually Look Like
If you gently lift your baby’s lip or run a clean finger along their gums, you may feel a hard ridge just beneath the surface. The gum tissue over an incoming tooth often looks red and slightly bulging compared to the surrounding area. Once the tooth is close, you can sometimes see a white line or small white dot where it’s about to emerge.
In some cases, a fluid-filled bump appears on the gum right before a tooth comes in. These are called eruption cysts, and they look bluish or clear. They’re most common toward the back of the lower jaw and almost always resolve on their own once the tooth pushes through. They look alarming, but they’re harmless and rarely need any treatment.
Teething Does Not Cause a Real Fever
This is one of the most persistent myths in parenting. Teething can cause a slightly elevated temperature, but it does not cause a true fever. Doctors define a true fever as 100.4°F (38°C) or higher. Teething stays below that line.
The timing is what creates the confusion. Babies begin teething right around the age when maternal antibodies start to fade, so they’re catching more colds and minor infections at the same time teeth are coming in. If your baby has a temperature of 100.4°F or above, something other than teething is responsible. For babies younger than 3 months, a rectal temperature at or above 100.4°F is considered serious and needs medical evaluation regardless of whether you suspect teething.
Teething vs. Ear Infection
Ear pulling is the symptom that trips up most parents. Teething pain can radiate from the jaw to the ears, so babies often tug at their ears during teething. But ear pulling is also a hallmark of ear infections, and telling the two apart matters.
The key differences come down to intensity and accompanying symptoms. With teething, ear pulling is occasional, the baby still has periods of being content, and you can see swollen gums. With an ear infection, the crying is more persistent and intense. Babies with ear infections often cry more when lying down because the position increases pressure in the ear. A fever above 100.4°F, fluid draining from the ear, or difficulty hearing and responding to sounds all point toward infection rather than teething. If ear pulling comes with any of those, it’s worth a call to your pediatrician.
Safe Ways to Ease the Discomfort
The American Academy of Pediatrics recommends solid rubber or plastic teething toys as a first-line option. They give your baby something firm to chew against, which helps relieve the pressure beneath the gums. Avoid liquid-filled teething rings, though. They can tear, leaving sharp edges that could cut your baby’s mouth, and the liquid inside may harbor bacteria.
A clean, damp washcloth chilled in the refrigerator (not the freezer) works well too. The cold numbs the gums slightly, and the texture gives your baby something to gnaw on. You can also gently rub your baby’s gums with a clean finger. Many babies find that pressure soothing, especially if your hands are cool.
Products to Avoid
Homeopathic teething tablets containing belladonna are not safe. The FDA issued a warning urging parents to stop using these products and throw away any they have at home. Testing of tablets sold by major brands found that the levels of active compounds, including atropine and scopolamine, varied wildly from tablet to tablet and in some cases far exceeded the amounts listed on the label. These are potent substances that pose a real risk to infants.
Topical numbing gels containing benzocaine also carry risks for young children. The numbing effect wears off quickly, the gel can be swallowed, and in rare cases it causes a serious blood condition. Stick to mechanical relief like teething toys, cold washcloths, and gentle gum massage. These are effective and carry no risk.
How Long Each Tooth Takes
The discomfort from a single tooth typically lasts a few days, peaking right before the tooth breaks through the gum surface and fading quickly once it does. The entire teething process stretches over about two years, since babies get 20 primary teeth total. But it’s not two years of constant misery. Each tooth has its own short window of discomfort, with plenty of comfortable stretches in between.
The lower front teeth usually arrive first, followed by the upper front teeth. Molars tend to cause more discomfort than the front teeth because they’re larger and have a broader surface pushing through the gum. If your baby seems more bothered around 12 to 15 months than they were at 6 months, molars are the likely culprit.