For a 4-month-old, the safest teething relief options are non-medicated: chilled washcloths, firm rubber teething rings, and gentle gum massage with a clean finger. Most pain medications and topical gels are either unsafe or not recommended at this age, so simple, hands-on remedies are your best tools.
Why Teething Starts This Early
Most babies get their first tooth between 4 and 7 months, but the discomfort often starts weeks before anything breaks through. At 4 months, you might notice more drooling than usual, a sudden interest in chewing on everything, or mild fussiness. Swollen, tender gums are common. These signs can come and go for weeks before you actually see a tooth.
One important thing to know: teething does not cause a true fever. It may nudge your baby’s temperature slightly above normal, but anything at or above 100.4°F (38°C) is a fever and signals an infection, not teething. The same goes for diarrhea and excessive crying, neither of which are caused by teething. If your baby has any of these, something else is going on.
Safe Remedies That Actually Help
The American Academy of Pediatrics recommends three main approaches for soothing teething pain at this age:
- Gum massage. Wash your hands, then gently rub your baby’s swollen gums with a clean finger. The pressure counteracts the discomfort of a tooth pushing upward. Many babies calm down quickly with this alone.
- Firm rubber teething rings. Choose a solid rubber ring, not one filled with liquid. Liquid-filled teethers can break and leak. You can chill the ring in the refrigerator for extra soothing, but don’t freeze it. A frozen teether becomes hard enough to bruise tender gums. Always stay nearby while your baby chews on one.
- Cold washcloths. Wet a clean washcloth and place it in the refrigerator for 15 to 20 minutes. The cold, textured fabric feels good to chew on and the slight pressure helps relieve soreness.
These methods are simple, but they work. You can rotate between them throughout the day depending on what your baby responds to best.
Pain Medication at 4 Months
Ibuprofen is not safe for babies under 6 months old. It has not been tested or approved for infants this young, so it’s completely off the table right now.
Acetaminophen (the active ingredient in infant Tylenol) can be used in younger babies, but only with your pediatrician’s guidance on the correct dose. Dosing for infants is based on weight, and getting it wrong can be harmful. If your baby seems truly uncomfortable and the non-medicated approaches aren’t enough, a call to your pediatrician is the right next step. They can tell you whether acetaminophen is appropriate and exactly how much to give based on your baby’s current weight.
Products to Avoid
Numbing Gels
Over-the-counter teething gels containing benzocaine (such as Orajel) should not be used in infants. Benzocaine can cause a rare but serious condition where the blood’s ability to carry oxygen drops dangerously low. The FDA and AAP both recommend against using any topical numbing agent on a baby’s gums.
Homeopathic Teething Tablets
Homeopathic teething tablets, including brands formerly sold by Hyland’s and CVS, have been the subject of multiple FDA warnings. Testing revealed that some tablets contained levels of belladonna (a toxic plant extract) far exceeding what was listed on the label, and the amounts varied unpredictably from tablet to tablet. Some tablets also contained inconsistent levels of caffeine. Several products were recalled, and the FDA issued warning letters to multiple manufacturers. If you have any homeopathic teething tablets at home, throw them away.
Amber Teething Necklaces and Jewelry
Amber necklaces are marketed with the claim that body heat releases a pain-relieving substance from the beads. There is no scientific evidence this works. What is well documented is the danger: the beads pose a choking hazard if the necklace breaks, and the necklace itself is a strangulation risk. The FDA issued an official warning after receiving reports of children choking on broken beads and an 18-month-old dying from strangulation during a nap. The AAP recommends that infants not wear any jewelry at all. Suffocation is the leading cause of death for children under one year old.
Feeding a Teething Baby
Teething discomfort can make feeding frustrating for both of you. Your baby may pull away from the breast or bottle, fuss during feeds, or try to chew instead of suck. A few adjustments can help.
Before a feeding, offer a cold washcloth or chilled teething ring for a few minutes to numb the gums slightly. You can also massage your baby’s gums with a clean finger right before latching. During breastfeeding, make sure your baby is well supported and properly latched, since a shallow latch is more likely to lead to biting. If your baby does bite, stay calm. A startled reaction can scare them. Instead, say “no bite” firmly, briefly turn them away from the breast, then try again. Babies pick up on this quickly and learn that biting ends the feeding.
If your baby is bottle-fed and refusing the bottle, try a slightly cooler temperature for the milk or formula. Some babies find the warmth irritating on sore gums.
Teething vs. Illness
Because teething overlaps with the age when babies start losing some of the immune protection they were born with, it’s easy to blame teething for symptoms that are actually caused by a virus or infection. The AAP has noted that teething babies are “little different from kids who are not teething,” meaning the process shouldn’t dramatically change your baby’s mood, sleep, or daily routine.
Watch for these signs that something beyond teething is happening: a temperature of 100.4°F or higher, diarrhea lasting more than a day, crying that is more frequent or intense than your baby’s normal fussiness, or a rash that isn’t localized around the mouth. Any of these warrant a call to your pediatrician. And if your baby’s temperature reaches 104°F (40°C), seek emergency care.