Baby Teething Guide: Signs, Timeline, Relief and When to Worry
Teething is one of the most attributed causes of baby distress, and one of the most misunderstood. Almost every symptom a baby shows between 4 and 24 months gets blamed on teething, which obscures real symptoms that deserve medical attention. This guide separates what teething genuinely causes from what it doesn't.
Teething Timeline: Which Tooth Comes When
| Teeth | Typical age | Normal range |
|---|---|---|
| Lower central incisors (bottom front 2) | 6–10 months | 4–15 months |
| Upper central incisors (top front 2) | 8–12 months | 6–14 months |
| Upper lateral incisors | 9–13 months | 7–16 months |
| Lower lateral incisors | 10–16 months | 7–18 months |
| First molars | 13–19 months | 12–24 months |
| Canines | 16–22 months | 14–24 months |
| Second molars | 25–33 months | 20–36 months |
No teeth by 12 months?
If your baby has no teeth by 12 months, mention it at their next routine check. Delayed teething (after 15 months with no teeth) warrants a dental referral to check for underlying causes, though in most cases it's simply normal variation. Some children don't get their first tooth until 14–16 months, this is within the normal range.
Real Teething Signs vs Myths
A landmark 2000 study by Wake et al. tracked teething symptoms carefully and found the following are genuinely associated with tooth emergence:
- Increased drooling, often the first sign, starting weeks before the tooth appears
- Gnawing and biting on objects, hands, or anything in reach
- Gum swelling and redness, visible in the area where the tooth is emerging
- Increased fussiness, particularly in the 4 days before and 3 days after tooth emergence (the "teething window")
- Slightly raised temperature, up to 38°C. NOT high fever.
- Cheek rubbing and ear pulling on the side where the tooth is coming in
What teething does NOT cause (despite widespread belief):
- High fever (above 38°C), always has another cause. Never attribute high fever to teething without ruling out illness.
- Diarrhoea. not caused by teething. The correlation exists because teething coincides with the age when babies start putting everything in their mouths, which increases gastrointestinal infections.
- Vomiting. not caused by teething. See a doctor.
- Significant sleep disruption, a 2011 meta-analysis found no significant association between teething and sleep disruption beyond the brief teething window.
Safe Relief Methods
- Chilled (not frozen) teething ring: Place in the fridge for 20–30 minutes. The cool pressure soothes inflamed gums. Do not freeze, frozen teethers can cause burns to gum tissue. Silicone teethers are safest, avoid latex (allergy risk) and very hard plastics.
- Gum massage: A clean finger pressed and rubbed firmly along the gum line provides counter-pressure that reduces teething discomfort. Wash hands thoroughly first.
- Chilled cucumber or carrot (6+ months): A cold, firm piece held under supervision. Always supervised and large enough not to be a choking hazard.
- Paracetamol (infant formulation): For genuine teething pain that is clearly distressing baby, infant paracetamol (Calpol, Doliprane, Apiretal) at the correct weight-based dose is safe and effective. Use only when needed, not preventively.
- Ibuprofen (6+ months): More effective than paracetamol for inflammation-based pain. Not suitable under 6 months or if baby has kidney or liver concerns. Check with your GP if unsure.
What to Avoid
⚠️ Products to avoid entirely
Teething gels with lidocaine or benzocaine: The UK MHRA and EU health authorities advise against these for babies. The anaesthetic can numb the throat (affecting swallowing) and has caused adverse reactions. Bonjela original (with choline salicylate) is also not recommended under 16 months, use the infant-specific formulation only.
Amber teething necklaces: No evidence of any benefit and present a documented strangulation and choking risk. Not recommended by any European health authority.
Homeopathic teething tablets/granules: No evidence of efficacy beyond placebo. Some products have also faced safety concerns in the US.
When to See a Doctor
- Temperature above 38°C, in a teething baby, this is illness, not teething. Contact your GP or paediatrician.
- Diarrhoea lasting more than 24 hours, also not teething; seek medical advice.
- No teeth by 15 months, mention to your dentist or paediatrician
- Tooth emerging in an unusual position or colour, worth a dental assessment
- Baby is very distressed and not responding to comfort, teething pain has limits. Prolonged extreme distress that doesn't respond to comfort measures warrants a call to your GP.
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