Teething is a normal, unavoidable developmental stage when a baby’s first set of teeth (primary or deciduous teeth) begins to break through the gum line. This journey generally starts when an infant is around six months old, though the onset can vary widely among children. The full set of 20 primary teeth typically finishes erupting by the time a child reaches two and a half to three years of age. While the whole timeline spans years, the discomfort associated with teething occurs in temporary, recurring phases as each tooth emerges.
The Overall Teething Timeline
Teething pain is cyclical, not continuous. A child’s primary teeth emerge in a predictable pattern, starting with the lower central incisors (bottom front teeth) usually between six and ten months, followed by the upper central incisors (top front teeth) between eight and twelve months.
The acute, painful phase for any single tooth is relatively short, typically lasting only a few days before the tooth visibly pushes through the gum. Once the tooth has fully emerged, the localized pain generally subsides until the next tooth begins its movement toward the surface.
The next phase involves the first molars, the large back teeth used for grinding food, which are significantly larger and usually erupt between 13 and 19 months. These first molars often cause more noticeable discomfort due to their size and shape. Following the molars, the canine teeth, the pointed teeth, appear between 16 and 23 months.
The final teeth to emerge are the second molars, which are the largest of the primary set and typically cause the final bouts of teething pain between 25 and 33 months. While a baby may experience episodes of pain over a period of two to three years, the discomfort for any one tooth is limited to a brief window.
Recognizing Signs of Discomfort
Identifying the source of a baby’s distress helps in providing comfort. A sign of teething is increased drooling, which can sometimes lead to a facial rash due to constant moisture exposure. The gums may appear mildly red or swollen at the site where a tooth is preparing to erupt.
Babies often try to relieve gum pressure by chewing intensely on almost any object. This increased desire to chew on toys, fingers, or crib rails is a direct response to the aching sensation beneath the gum line. Other behavioral indicators include general irritability, fussiness, and sometimes a disruption in normal sleeping or eating patterns. Some infants may also rub their cheeks or pull at their ears on the side where a tooth is erupting, as the pain can radiate to those areas.
Strategies for Pain Management
Managing the discomfort involves a combination of non-medicated methods and, when necessary, approved medications. One of the simplest and most effective non-medicated strategies is to apply gentle counter-pressure to the gums. A parent can lightly massage the baby’s gums with a clean finger or offer a firm, rubber teething ring for the infant to chew on.
Cold temperatures can provide temporary relief by numbing the gums and reducing inflammation. Items such as a chilled, wet washcloth or a clean teething toy placed in the refrigerator can be offered to the baby. It is important to note that teething objects should only be chilled, not frozen solid, as excessively hard or frozen items can potentially bruise the baby’s tender gum tissue.
If non-medicated approaches are not sufficient to manage the pain, over-the-counter pain relievers may be considered after consulting a healthcare provider. Acetaminophen can be used for infants two months of age and older, while ibuprofen is appropriate for babies six months and older. Dosage must be strictly based on the child’s weight, not age, and professional guidance should always be sought before administering medication.
Parents should avoid topical anesthetic gels containing benzocaine, as they are not recommended for infants and can pose safety risks if swallowed or used improperly. Parents should also avoid unproven products like teething necklaces made of amber, due to the risks of choking and strangulation. Providing safe, consistent comfort helps the baby through the acute phase until the tooth emerges.
When Symptoms Indicate More Than Teething
While teething causes localized inflammation and discomfort, it does not typically cause systemic illness. Teething may result in a slightly elevated temperature, but a true fever (100.4°F or 38°C or higher) is not directly caused by tooth eruption. If a baby develops a fever, it is an indication of a separate underlying illness, such as a viral infection, and should not be dismissed as merely teething.
Similarly, symptoms like vomiting, severe diarrhea, or a widespread body rash are not considered part of the normal teething process. If a baby exhibits any of these symptoms alongside the typical signs of teething, or if the infant is inconsolable or refusing to drink liquids, professional medical advice is warranted. These symptoms suggest a separate condition requiring evaluation by a pediatrician to rule out infection or other health concerns.