Most babies start teething between 4 and 7 months old, and the signs are usually a combination of fussiness, drooling, and a sudden urge to chew on everything in sight. No single symptom confirms teething on its own, but when several show up together, you can be fairly confident that a tooth is on its way.
The Most Reliable Signs of Teething
The clearest physical sign is a change in your baby’s gums. Where a tooth is about to come through, the gum tissue will look red and swollen, and it may feel firm or bumpy when you run a clean finger over it. Sometimes you can see the faint white outline of a tooth just below the surface. In rare cases, a small bluish blister (a fluid-filled bump over the erupting tooth) appears on the gum. This looks alarming but is harmless and resolves on its own once the tooth breaks through.
Beyond the gums, teething typically produces a cluster of behavioral changes:
- Increased drooling. This is often the earliest sign, sometimes starting weeks before a tooth appears. You may notice a rash on the chin or cheeks from constant moisture.
- Chewing on hands, toys, or anything nearby. The pressure of biting down on something firm helps relieve gum discomfort, so babies instinctively seek it out.
- Irritability and fussiness. Your baby may seem crankier than usual, especially in the days right before a tooth breaks through. This is typically on-and-off rather than constant.
- Disrupted sleep. Some babies who previously slept well will start waking more at night or resist naps.
- Mild changes in feeding. Sucking can create pressure on sore gums, so a baby who normally nurses or takes a bottle eagerly might pull away or seem reluctant. Babies on solids sometimes prefer cold or soft foods.
- Ear pulling or cheek rubbing. Pain from the gums can radiate to the ears and jaw, so babies sometimes tug at their ears or rub the side of their face.
Symptoms for each tooth tend to be worst in the few days before and after it breaks through the gum line, then settle down until the next tooth starts moving.
What Teething Does Not Cause
Teething gets blamed for a lot of things it doesn’t actually produce. It does not cause a true fever. It may raise your baby’s body temperature slightly, but a reading of 100.4°F (38°C) or higher is a fever, and a fever signals an infection rather than a tooth coming in. If your baby hits that threshold, something else is going on.
Teething also doesn’t cause diarrhea, vomiting, a widespread body rash, or extreme lethargy. Because teething happens during the same months that babies lose their maternal antibodies and start putting everything in their mouths, infections are common during this period. It’s easy to connect a runny nose or stomach bug to a new tooth, but teething isn’t the cause. If your baby seems genuinely sick rather than just cranky, treat those symptoms on their own merits.
Teething vs. Ear Infection
Ear pulling is one of the trickiest teething signs to interpret because it can also point to a middle ear infection. Here’s how to tell the difference: teething-related ear pulling is usually mild, comes and goes, and isn’t accompanied by cold symptoms. An ear infection, by contrast, often follows a cold or respiratory illness and comes on suddenly. Babies with ear infections tend to be more intensely uncomfortable, especially when lying flat, and they frequently have a fever above 100.4°F. You might also notice a runny nose, cough, or in some cases drainage from the ear itself. If the ear pulling is frequent, intense, or paired with fever and feeding refusal, it’s worth having your baby’s ears checked.
Which Teeth Come In First
The two lower front teeth (central incisors) are almost always first, usually arriving between 6 and 10 months. The two upper front teeth follow shortly after. From there, teeth generally fill in from front to back: the lateral incisors on either side of the front teeth, then the first molars, the canines (the pointy ones), and finally the second molars. Most children have all 20 baby teeth by age 3.
Some babies are early starters, showing their first tooth as young as 4 months, while others don’t get one until after their first birthday. Both ends of this range are normal. The timeline varies widely and doesn’t reflect anything about your baby’s overall development.
Safe Ways to Ease Teething Pain
The simplest relief is also the most effective. Rub your baby’s gums gently with a clean finger. The counter-pressure soothes the ache, and most babies visibly calm down within a minute or two. A teething ring made of firm rubber gives your baby something safe to chew on. Chilling the ring in the refrigerator (not the freezer, which makes it too hard and can hurt tender gums) adds a mild numbing effect.
A clean, cold washcloth works well too. Wet it, wring it out, and let your baby gnaw on it. For babies who are already eating solids, chilled foods like cold fruit in a mesh feeder can do double duty as a snack and a teething tool.
Products to Avoid
Numbing gels and teething tablets are widely sold but not safe for babies. The FDA has issued explicit warnings against using any product containing benzocaine or lidocaine for teething pain in children. Benzocaine can trigger a rare but serious condition that reduces the blood’s ability to carry oxygen. Lidocaine solutions can cause seizures, heart problems, and severe brain injury if too much is applied or accidentally swallowed. These products offer little to no actual benefit for teething pain, even when used as directed.
Homeopathic teething tablets fall under the same warning. The FDA has found inconsistent levels of toxic ingredients in some of these products and advises against using them. Amber teething necklaces pose a strangulation and choking hazard with no proven pain-relieving benefit.
When That First Tooth Arrives
Once you can see a tooth, start cleaning it. A soft infant toothbrush with a rice-grain-sized smear of fluoride toothpaste is all you need, twice a day. The American Dental Association recommends scheduling your baby’s first dental visit after the first tooth appears and no later than their first birthday. This early visit is mostly about establishing a baseline and catching any issues with how the teeth and jaw are developing.