As is the case with many stages of development that you will parent your child through, teething can be unpredictable and difficult to navigate. Every child is unique and develops differently. Some babies have significant signs of teething, while others have none at all before you notice that a tooth has suddenly popped through. Unfortunately, some little ones are quite uncomfortable as they teethe and, as parents, we don’t always know what’s wrong or what we can do to help. This can be overwhelming and frustrating for both the parent and child.
How to Know Whether Your Baby is Teething
What is the developmental process of teeth?
Teeth actually start developing in the baby before they are even born. Good nutrition from the mother during pregnancy is important in tooth development. The mother’s diet should have adequate amounts of calcium, phosphorus, vitamin C, and vitamin D. Certain medications, such as tetracycline, should not be taken during pregnancy (it can cause the developing teeth to be discolored). The first stage of tooth development begins at about 6 weeks of gestation; this is when the basic substance of the tooth forms. Next, the hard tissue that surrounds the teeth is formed at around 3 to 4 months gestation. After the child is born, the next stage occurs when the tooth actually protrudes through the gum.
The entire teething process in your child can last quite a long time, anywhere from 5 to 30 months. From the time we visualize swelling of the gums, it could take two weeks or longer for any one tooth to break through. Pain and other symptoms specific to teething typically peak the few days leading up to the tooth erupting. This can confuse parents because some things that might look like teething are actually normal developmental milestones and might be mistaken for teething. For example, excess drooling arises when a baby is 3-4 months old as their salivary glands develop, and babies exploring by putting their hands and objects in their mouth is also a normal milestone at 3-4 months.
When will my child get their first tooth? Which will it be?
The order of teeth eruption may vary. Teeth often come through in pairs, and the most common first teeth are the lower central incisors (the front two on the bottom), and the middle top pair follows not long after. But, there’s no telling which you’ll see first. The age you will see your baby’s first tooth also varies from child to child, seemingly with little rhyme or reason. The average age is 6-7 months, but some appear as early as 3-4 months, and others may not emerge until 12 months old or even later.
It’s rare, around one in 2,000 births, but some babies are actually born with teeth called natal teeth. These can be affixed to the root and fully developed, loose without roots, or even just small buds poking through the gums.
Research has shown that girls usually get their teeth before boys and lose them before boys too. Children typically have all 20 of their primary teeth by the age of 3 years. Another interesting fact about teeth is that they often fall out in the same order as they came in. The average age that children begin to lose their teeth is 6 years old, and they will have shed all their baby teeth by the time they are 12.
What are the signs or symptoms my child may show when teething?
There are several symptoms and signs of teething, some of which can be quite vague, including:
- excessive drooling (this helps moisten gums and reduces inflammation)
- mouthing objects, biting (which can be quite uncomfortable for breastfeeding mothers!), chewing on hands
- tender red swollen gums
- pulling at the ears or rubbing their cheeks
- elevated temps — a baby’s body temperature may slightly rise when teething; however, a true fever, defined as a temperature over 100.4 degrees, is not associated with signs of teething, so be sure to speak to your pediatrician if this occurs!
- changes in sleeping or eating patterns
- loose stools
Studies have not revealed a direct correlation between teething and diaper rash. However, new teeth stimulate excess saliva production, including a digestive enzyme that leads to a change in stool acidity with subsequent irritated skin. As prevention, apply an ointment such as petroleum jelly (Vaseline®) directly on the skin to act as a protective barrier, allow open air time as able, and apply diaper rash creams with zinc oxide when indicated.
If your child begins to show signs of rash, fever, or diarrhea, you should consult your child’s pediatrician right away.
What can I do to help comfort my teething baby?
Here are some tips of ways to comfort your child from the first signs of teething:
- Gentle gum massage with a clean finger
- Cold, soft foods such as yogurt or bananas or frozen teething pops made with healthy ingredients or even breastmilk
- Extra nursing (the rhythmic motion comforts some babies)
- Offer a clean teether to chew on — chilled (freezer-safe), solid, non-toxic (BPA-free), colorful, and able to be held by baby, without small parts that can fall off. Examples of good teethers are cold spoons, gauze pads, and specially designed firm rubber teething rings
- A favorite washcloth teether — knot a washcloth on one or both ends and dip the knot in breastmilk, formula, or water. Put it in the freezer for 15-30 min. Don’t freeze it all the way, so there is still some give so your child can chew on it. Attach it to a pacifier clip, toy, or give it right to the baby.
- Children’s acetaminophen (Tylenol®) or ibuprofen (Motrin® or Advil®) may be used if your child seems to be in considerable pain. Read the label to know the right dose for your child, or check with your child’s doctor first. Do not give ibuprofen to children younger than 6 months.
What teething treatments should I avoid?
There are a few treatments that I do not recommend for teething:
- Do NOT use numbing gels with benzocaine or homeopathic teething tablets that contain belladonna. Benzocaine and belladonna are marketed to numb your child’s pain, but the FDA has issued warnings against both due to potential side effects.
- Amber teething necklaces and bracelets are also not recommended. Necklaces placed around an infant’s neck can pose a strangulation risk or be a potential choking hazard. There is also no research to support the necklace’s effectiveness.
- Do not offer teething rings with fluid inside or any plastic objects that might break off.
How do I properly care for my baby’s new teeth?
Once your child has a tooth, you should begin brushing them twice a day with a smear of fluoride toothpaste the size of a grain of rice, especially after the last drink or food of the day. Remember, oral health starts early. Ask your pediatrician about your child’s teeth and the need for fluoride varnish or supplementation. Be sure to establish a dental home (aka, establish care with a dental office). All children need access to a dentist for regular care. The American Academy of Pediatrics recommends all children see their dentist by their first birthday or within six months of their first tooth. Speak to your pediatrician about the right time for your child, as the appropriate age may depend on risk factors.