Most babies start teething between 4 and 7 months old, and the earliest signs are usually swollen gums, extra drooling, and a sudden urge to chew on everything within reach. These signals can appear days or even weeks before a tooth actually breaks through, which makes it tricky to pin down exactly what’s happening. Here’s how to recognize real teething symptoms, what’s often mistaken for teething, and the safest ways to help your baby through it.
What Teething Gums Look Like
The most reliable way to tell if your baby is teething is to look at and feel their gums. Right before a tooth erupts, the gum tissue directly above it becomes red, swollen, and tender. If you run a clean finger along the gum line, you may feel a hard bump just beneath the surface. In some cases, you’ll see a small bluish or translucent blister on the gum called an eruption cyst. This looks alarming but is harmless and typically resolves on its own once the tooth pushes through.
The lower front teeth (central incisors) almost always come in first, so start by checking the center of the bottom gum. The upper front teeth usually follow. By age 3, most children have all 20 primary teeth, but the process is rarely smooth or predictable. Some babies cut teeth with barely a fuss; others have several rough days per tooth.
Behavioral Signs to Watch For
Before you can see any gum changes, your baby’s behavior often shifts. The most common signs include:
- Increased chewing and biting. Babies instinctively press objects against their gums because the counter-pressure helps relieve discomfort. You’ll notice them gnawing on toys, fingers, the edge of a crib, or your shoulder.
- Extra drooling. Teething stimulates saliva production. Some babies drool so much it soaks through bibs and causes a mild rash on the chin, cheeks, or chest.
- Irritability and fussiness. The discomfort tends to come in waves, especially in the hours before a tooth breaks the surface. Your baby may be fine one moment and inconsolable the next.
- Disrupted sleep. Many parents notice their baby waking more often at night or resisting naps during active teething episodes.
- Changes in feeding. Some babies nurse or bottle-feed more for comfort. Others pull away because the sucking motion puts pressure on sore gums.
- Ear pulling or cheek rubbing. Pain from the gums can radiate along the jaw, so babies sometimes tug at their ears or rub the side of their face. This doesn’t mean they have an ear infection, but it’s worth noting if it comes with a fever.
Symptoms That Aren’t Actually Teething
A persistent myth is that teething causes fevers, diarrhea, and runny noses. Research consistently shows that teething does not cause true fevers. A temperature of 100.4°F (38.0°C) or higher is a fever, and something other than teething is responsible. The timing is coincidental: babies begin teething around the same age that protection from their mother’s antibodies starts to fade, so infections become more common.
Loose stools sometimes appear during teething, but teething itself isn’t the cause. Sore gums can encourage babies to drink or nurse more frequently, and the extra fluid intake can soften stool. Actual diarrhea, especially if frequent or watery, points to a stomach bug or dietary issue rather than a new tooth. The same goes for a persistent runny nose or congestion. These are signs of a cold or other illness, not a side effect of cutting teeth.
The real teething symptoms are relatively minor: drooling, gum tenderness, fussiness, and chewing. If your baby seems genuinely sick, that’s a separate issue worth addressing on its own rather than chalking it up to teeth.
Which Teeth Come In and When
Every baby is different, but teeth generally follow a predictable order. The bottom two front teeth appear first, typically between 6 and 10 months. The top two front teeth come next, around 8 to 12 months. Lateral incisors (the teeth flanking the front ones) fill in between 9 and 16 months. First molars arrive around 13 to 19 months, and these tend to cause more discomfort because of their larger, flatter surface. Canines (the pointed teeth between the incisors and molars) erupt around 16 to 23 months. Second molars, the last to arrive, show up between 23 and 33 months.
Some babies are born with a tooth already visible. Others don’t get their first tooth until after their first birthday. Both extremes are normal. The order matters more than the timing. If teeth arrive out of the usual sequence, it’s rarely a concern, but you can mention it at your baby’s first dental visit, which the American Academy of Pediatric Dentistry recommends scheduling by 12 months of age.
Safe Ways to Soothe Teething Pain
Gum Massage
The simplest and most effective technique is direct pressure. Find the swollen or irritated spot on your baby’s gum and rub it firmly with a clean finger for about two minutes. You can repeat this as often as needed. The pressure works against the sensation of the tooth pushing upward and often calms a fussy baby quickly.
For babies older than 12 months, you can wrap a small piece of ice in a wet washcloth and use it to massage the gum. For younger babies, skip the ice and stick with your finger or a chilled (not frozen) washcloth.
Teething Rings and Cold Therapy
Chilled teething rings, pacifiers, or wet washcloths give your baby something safe to gnaw on while the cold helps numb the area. Chill these items in the refrigerator, not the freezer. Frozen objects can be hard enough to bruise tender gums or cause frostbite. For babies over 12 months, a piece of chilled banana can serve the same purpose.
Avoid hard foods like raw carrots, which pose a choking risk. And steer clear of teething necklaces made from amber, silicone, or wood. These products have caused choking and strangulation incidents, are not FDA-approved, and have no proven benefit.
Over-the-Counter Pain Relief
If your baby is visibly uncomfortable despite cold therapy and gum massage, infant acetaminophen is an option for babies over 8 weeks old. Infant ibuprofen can be used for babies 6 months and older. Dosing is based on your baby’s weight, not age, so check with your pediatrician or follow the weight-based chart on the packaging carefully.
Products to Avoid
The FDA has issued direct warnings against using numbing gels or creams containing benzocaine or lidocaine on teething babies. Benzocaine can trigger a condition called methemoglobinemia, where the blood loses much of its ability to carry oxygen. It can be fatal. Lidocaine solutions can cause seizures, severe brain injury, heart problems, and death in infants and young children, especially if too much is applied or accidentally swallowed.
Homeopathic teething tablets fall under the same warning. Despite their reputation as “natural,” the FDA has found inconsistent levels of active ingredients in these products, and some have been linked to serious adverse events in children. The bottom line: topical numbing agents and homeopathic teething products carry real risks and offer little to no measurable benefit for teething pain.
How Long Each Episode Lasts
The worst discomfort typically lasts only a few days per tooth, concentrated in the period right before and right after the tooth breaks through the gum. Once the tooth is fully visible, the soreness fades quickly. That said, because 20 teeth come in over roughly two and a half years, teething can feel like a near-constant process during the first year. There are usually breaks between teeth, and not every tooth causes the same level of fussiness. Incisors tend to be milder. Molars, with their broad surfaces, often produce the most noticeable discomfort.
If your baby’s irritability, poor sleep, or feeding difficulties persist well beyond a few days and no new tooth appears, the cause is likely something else. Ear infections, in particular, can mimic teething symptoms like ear pulling and nighttime fussiness.