Teething Pain: Signs, Stages & What Actually Works

Most babies cut their first tooth somewhere between 4 and 12 months, and the weeks surrounding each eruption can be rough — for the baby and the parent both. Here is what the evidence says about what actually helps, what is safe to avoid, and when to call your doctor.

Fact-Checked & Transparent: This article is fact-checked against current CDC, WHO, ACOG, and NHS guidelines. All health information is based on authoritative medical sources. Last verified: June 2026.

⚠️ MEDICAL DISCLAIMER

This article is educational information only. It is NOT a substitute for professional medical advice, diagnosis, or treatment.

Always consult your pediatrician or healthcare provider before making any medical decisions for your baby or child. Every baby is unique, and professional medical guidance is essential.

In case of emergency, call 911 or your local emergency number.

When Does Teething Start?

Most babies begin teething between 6 and 10 months, though some start as early as 3 months and a few don't see their first tooth until after their first birthday. Both extremes are normal. By age three, most children have all 20 primary teeth.

The typical order of eruption:

• Lower central incisors (bottom front two) — usually first, around 6–10 months
• Upper central incisors — 8–12 months
• Upper lateral incisors — 9–13 months
• Lower lateral incisors — 10–16 months
• First molars — 13–19 months
• Canines — 16–22 months
• Second molars — 25–33 months

Each eruption can cause a few days of discomfort on either side of the tooth breaking through.

Signs Your Baby Is Teething

Not every baby shows the same signs, and some sail through teething with minimal fuss. Common signs include:

• Increased drooling — saliva production spikes to lubricate the gums
• Chewing and gnawing — biting provides counter-pressure that relieves discomfort
• Red or swollen gums — visible swelling over where the tooth is emerging
• Fussiness and crying — particularly in the evenings when distractions are fewer
• Disturbed sleep — waking more often than usual
• Refusal to feed — sucking creates negative pressure that can intensify gum pain

What Teething Does NOT Cause

This is important: teething does not cause fever, diarrhoea, or vomiting. The NHS, AAP (American Academy of Pediatrics), and WHO all agree on this. A temperature above 38°C (100.4°F) or loose stools during teething should be treated as a separate illness and assessed by your healthcare provider — not attributed to teething.

Remedies That Actually Help

1. Cold pressure on the gums

Cold reduces inflammation and the counter-pressure distracts the nerves. Options:

• A chilled (not frozen) teething ring — place in the fridge for 30 minutes, not the freezer. Frozen teethers can damage delicate gum tissue.
• A cold, wet flannel — fold it and let your baby chew on the corner. Simple and effective.
• Cold puree or yoghurt — once your baby is on solids, chilled apple puree or plain yoghurt provides the same combination of cold and chewing resistance.

2. Gum massage

Press a clean finger firmly along the swollen gum for 1–2 minutes. Many babies find the direct counter-pressure more satisfying than a teether. The friction stimulates blood flow and can temporarily numb the area.

3. Distraction

Babies who are engaged and stimulated feel teething pain less acutely. A walk outside, a new toy, or extra skin-to-skin time can get you through a difficult patch without needing any intervention at all.

4. Infant paracetamol or ibuprofen (when appropriate)

For significant distress — particularly at night — the NHS recommends sugar-free infant paracetamol or ibuprofen at the correct dose for your baby's weight and age. Ibuprofen is not suitable under 3 months; paracetamol can be used from 2 months following vaccination. Always follow the dosing instructions on the packaging and do not exceed the stated dose.

The Evidence Behind Common Remedies

The teething remedy market is large, and many products are sold on the basis of anecdote rather than clinical evidence. It is worth understanding what the research actually says about the options most parents reach for.

Teething gels containing lidocaine or benzocaine

These are no longer recommended for children under two. The FDA issued a strong warning against benzocaine-containing gels (such as Orajel) for infants after reports of methemoglobinemia — a condition where haemoglobin is converted to a form that cannot carry oxygen, causing a dangerous drop in blood oxygen levels. In the UK, lidocaine-based gels sold for teething (such as older formulations of Bonjela) carry similar concerns. The NHS advises against using these products in children under two. The numbing effect is also short-lived and washed away by saliva within minutes.

Amber teething necklaces

Amber teething necklaces are not recommended. The AAP, NHS, and Canadian Paediatric Society have all issued statements against them. There is no clinical evidence that amber releases succinic acid in quantities sufficient to have any analgesic effect when worn. More critically, necklaces around an infant's neck present real risks of strangulation if a loop catches on something, and the individual beads are a choking hazard if the string breaks. Several deaths and near-deaths have been reported internationally. The safety risk is not theoretical — it is documented. No teething product is worth those risks.

Teething rusks

Teething rusks are high in sugar. Most standard teething rusks contain 30–40% sugar by weight. While babies enjoy the texture and chewing resistance, the sugar content contributes to tooth decay — particularly when the teeth they are meant to soothe are only just erupting. The NHS advises limiting sugary foods and drinks from the point at which teeth appear. Plain rice cakes, cucumber sticks (supervised), or chilled bread crusts provide the same chewing benefit without the sugar load.

Cold foods in a mesh feeder

Placing chilled fruit — banana, mango, or melon — inside a mesh feeding pouch allows a baby to gnaw and get cold counter-pressure on the gums with no choking risk. The evidence base is reasonable: cold reduces inflammation, and the mechanical stimulation of chewing provides distraction from pain. The AAP considers chilled (not frozen) solid foods a sensible option for babies who are already eating solids.

Purpose-made teething toys

Silicone or rubber teething toys with no liquid filling have a good safety profile. They are easy to chill, easy to clean, and pose no risk of bursting or leaching. Avoid gel-filled teethers (they can puncture) and any teether made with small, detachable parts. The British Standards BS EN 12586 standard applies to teethers sold in the UK — check packaging for compliance.

Shop Best Teething Toys

Products to Avoid and Why

To summarise clearly:

• Benzocaine/lidocaine teething gels — risk of methemoglobinemia; not recommended under 2 years
• Amber teething necklaces — no evidence of efficacy; documented strangulation and choking risk
• Frozen teethers — ice-cold temperatures can damage gum tissue; use fridge-chilled only
• Teething rusks — high sugar content damages erupting teeth
• Herbal teething powders (e.g., products containing belladonna) — the FDA has warned against homeopathic teething tablets and gels containing belladonna after reports of serious adverse effects
• Gel-filled teething rings — risk of puncture and leakage; solid silicone alternatives are safer

When Teething Isn't Teething

Because teething causes general unsettledness, it is frequently blamed for symptoms that are actually caused by something else. Several conditions commonly arise in the same age window and are worth ruling out before attributing everything to teeth.

Ear infections — Otitis media (middle ear infection) is common between 6 and 18 months. It causes ear pain, fussiness, disrupted sleep, and sometimes fever. It does not cause drooling or gum swelling. If your baby is particularly distressed when lying down, pulling at one ear, or running a temperature, have their ears checked rather than assuming it is teeth.

Viral illness — Many common viral infections of infancy, including hand, foot and mouth disease, herpangina, and general upper respiratory viruses, cause mouth discomfort, drooling, and feeding refusal — all symptoms easily mistaken for teething. If your baby has spots in or around the mouth, a rash on the palms or soles, or seems systemically unwell, see your GP.

Roseola (roseola infantum) — Roseola typically causes 3–5 days of high fever followed by a characteristic pink rash across the trunk. During the fever phase, before the rash appears, it can look like a bad patch of teething. A temperature above 38°C is not normal for teething and should prompt a clinical assessment rather than paracetamol and waiting.

Oral thrush — White patches on the tongue, gums, or inner cheeks are not teething — they indicate oral thrush, a yeast infection that requires antifungal treatment. It can cause feeding discomfort but needs different management.

The Full Timeline: 20 Teeth by Age Three

Teething is not a single event — it is a multi-year process. Understanding the full timeline helps normalise what feels like an endless series of difficult weeks.

Babies are born with all 20 primary teeth already formed beneath the gum line. The first tooth (usually a lower central incisor) typically erupts around 6–10 months. The second molars — the last primary teeth — usually appear between 25 and 33 months, completing the set.

That means teething, in various phases of intensity, spans roughly two and a half years. Not every tooth causes significant distress — the incisors, which are thin and sharp, often come through with less drama than the molars, which have a larger surface area breaking through the gum. Most parents find the first molar phase (around 13–19 months) the most challenging.

By age three, your child should have a full set of 20 primary teeth: 8 incisors, 4 canines, and 8 molars. The first dental check should happen around the time the first tooth appears, or by their first birthday at the latest — whichever comes first. NHS dental care for children is free.

When to Call Your Doctor

Contact your GP or pediatrician if:

• Your baby has a temperature above 38°C (100.4°F)
• Diarrhoea, vomiting, or a rash appears alongside the fussiness
• Your baby is refusing all feeds for more than 24 hours
• No teeth have appeared by 18 months
• A tooth appears discoloured or in an unusual position

These symptoms point to something separate from teething and need proper assessment.

Teething and Sleep

Sleep disruption during teething is real, but it is usually brief — 2 to 4 nights around the time a tooth breaks through. Keeping the same bedtime routine and responding to your baby's cues consistently helps them settle back to their normal pattern faster. Avoid introducing new sleep associations (feeding to sleep, bringing into your bed) that you will need to unpick later, unless you are comfortable with them long-term.

The Bottom Line

Cold pressure, gum massage, and age-appropriate pain relief are the most effective tools for teething discomfort. The phase is temporary — each tooth typically causes only a few days of noticeable fussiness. Fever or illness during teething should be assessed separately, as teething alone does not cause a raised temperature.

Frequently Asked Questions

Do amber teething necklaces work?

No. There is no clinical evidence that amber releases enough succinic acid through skin contact to have any pain-relieving effect. More importantly, necklaces around an infant's neck pose a genuine strangulation and choking risk. The AAP, NHS, and Canadian Paediatric Society all advise against them. Do not use them.

Can I use teething gel on my baby?

Standard teething gels containing benzocaine or lidocaine are not recommended for children under two years. In the UK, the NHS advises against lidocaine-based teething gels in infants. If you want a topical option, ask your pharmacist about products that do not contain local anaesthetics — but note that evidence for these is also limited.

My baby has had a temperature during teething. Is that normal?

A true fever (above 38°C / 100.4°F) is not caused by teething. The NHS, AAP, and WHO all agree on this. If your baby has a fever, treat it as a separate concern and contact your GP or call NHS 111 if you are unsure.

When should my baby's first dental appointment be?

The British Dental Association and NHS recommend a first dental visit around the time the first tooth appears, or by 12 months at the latest. NHS dental care is free for children. Early appointments help your child get used to the dental environment and allow the dentist to check for any early issues.

Are teething rusks safe?

Teething rusks are safe in the sense that they are non-toxic, but most are high in sugar — which is problematic for erupting teeth. Plain rice cakes, bread crusts, or chilled vegetable sticks are better alternatives for a baby who wants something to chew.

What is the safest teething toy?

Solid silicone or natural rubber teething toys with no liquid filling and no small parts are the safest option. Look for products that meet BS EN 12586 in the UK. Place in the fridge (not freezer) before use for added relief.

Key Takeaways

• Most babies cut their first tooth between 6 and 10 months, and all 20 primary teeth are typically in place by age three
• Teething does not cause fever, diarrhoea, or vomiting — these symptoms need separate assessment
• Cold pressure (chilled teethers, wet flannels, chilled solid foods) and gum massage are the most evidence-supported remedies
• Amber teething necklaces carry a documented strangulation and choking risk and have no clinical evidence of benefit — avoid them
• Lidocaine and benzocaine teething gels are not recommended for children under two by the NHS and FDA
• Symptoms resembling teething — particularly fever, ear pulling, or rash — may indicate ear infection, viral illness, or roseola and should be assessed by a healthcare provider

📋 SOURCES & FACT-CHECKING

This article is compiled and verified against these authoritative sources: - CDC (Centers for Disease Control & Prevention) - WHO (World Health Organization) - ACOG (American College of Obstetricians and Gynecologists) - NHS (National Health Service) - AAP (American Academy of Pediatrics)

Last verified: June 2026

Educational content only. Always consult your pediatrician for medical decisions.

Related Articles

• Baby Eczema Treatment Prevention
• Baby Fever Temperature When Dangerous
• Baby Thrush Breastfeeding Treatment
• Ear Infections Babies Signs Treatment
• Baby Constipation Diarrhea Signs