Baby Teething: When It Starts and What Actually Helps

First teeth usually appear between six and ten months, though discomfort can start weeks or even months earlier. The order is fairly reliable: the lower central incisors, the front two on the bottom, come first, and by around three years a child has all twenty baby teeth.

The range either side of that is wide and uninformative. A baby born with a tooth and a baby with nothing at twelve months are both within normal variation, and neither predicts anything about the teeth that follow.

Drooling, an urge to chew hard things, and gums that are visibly swollen and tender around the emerging tooth. Fussiness follows from the last of those, and it can disrupt sleep for a few days around each tooth.

A rash on the chin and neck is common and is not teething as such: it is saliva irritating skin, which is why it responds to keeping the area dry rather than to anything you do about the tooth.

• Drooling, and the chin rash that comes with it
• Chewing on anything firm within reach
• Swollen, tender gums where a tooth is coming through
• Fussiness and broken sleep for a few days around each tooth

The AAP's teething guidance is blunt about it: many parents expect a fever when baby teeth break through, and extensive studies show this is a false symptom of teething. The same guidance says diarrhoea, heavy crying and nappy rash are not caused by teething either.

There is a wrinkle worth being honest about. The FDA's page on teething, summarising AAP, lists a low-grade fever among the occasional symptoms. So two sources we trust differ in emphasis, and this page is not going to pretend otherwise or pick a winner.

What matters is that the practical rule is the same under either reading. A genuine fever should be treated as something other than teething and taken to a doctor if it meets the threshold your paediatrician has given you for your child's age. The risk here runs in one direction only: nobody has ever been harmed by investigating a fever that turned out to be nothing, and children have been harmed by an illness explained away as a tooth.

The recommendations are unglamorous and they are what both the AAP and the FDA point to. Rub or massage the gums gently with a clean finger. Offer a firm rubber teether, not a liquid-filled one, and do not freeze it: a teether hard enough to be frozen is hard enough to bruise gums. A cold damp washcloth does much the same job and costs nothing.

Supervision matters with any teether, since the object is being chewed by a baby whose whole aim is to break bits off it.

If your baby seems genuinely uncomfortable rather than grumpy, the AAP's advice is to ask your paediatrician about pain relief such as acetaminophen, which is a conversation about your child's weight and age rather than something to work out from a box.

• A clean finger, massaging the gum
• A firm rubber teether, never liquid-filled, never frozen
• A cold damp washcloth
• Ask your paediatrician before giving any pain medicine

Benzocaine is the numbing agent in several over-the-counter oral products, Orajel and Anbesol among them. The FDA states plainly that these should not be used for teething pain in children, because benzocaine can cause methemoglobinemia, a condition in which the blood's ability to carry oxygen is severely reduced. It can be fatal.

Prescription viscous lidocaine carries its own FDA warning for this use, which names heart problems, severe brain injury, death, and seizures when too much is applied or it is swallowed.

Teething jewellery is the other one, and it is not a theoretical risk. The FDA has received reports of death and serious injury from strangulation and choking caused by teething necklaces, amber ones included. The material makes no difference: amber, wood, marble and silicone all pose the same two risks, a cord around a neck and a bead in an airway.

Homeopathic teething tablets and gels are on the same avoid list, as are alcohol and belladonna preparations.

• Benzocaine gels and creams, at any age
• Viscous lidocaine
• Teething necklaces and bracelets, of any material
• Homeopathic teething tablets, belladonna, alcohol
• Liquid-filled or frozen teethers

Brushing starts with the first tooth, and the first dental visit is due at the first tooth or the first birthday, whichever comes first, which is earlier than most families expect.

The other habit that matters at this age is what goes in the bottle and when. Milk pooling around new teeth overnight is what causes early childhood caries, which is the reason the bottle has a deadline of its own.

A real fever, any difficulty feeding that persists, or a baby who seems unwell rather than uncomfortable. Teething makes babies grumpy; it does not make them ill, and the distinction is the useful one.

No teeth at all by around eighteen months is worth mentioning at a checkup, though it is usually a matter of timing rather than a problem.