Teething: What It Causes, What It Does Not, and Safe Relief
Teething (daant nikalna) gets blamed for everything between 4 months and 3 years: fevers, diarrhoea, chest colds, rashes, nights of screaming. It causes almost none of them. Here is what a tooth coming through actually does, what safe relief looks like, and why the gels, the amber necklaces and the honey on the gums are out.
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Teeth do not cause fever. Germs do. A hot, teething baby is a baby with an infection.
When teeth come, and in what order
The first tooth usually appears between 4 and 10 months, most often around 6, nearly always one of the bottom front two, followed by the top front pair, the teeth beside them, the first molars at around a year, the canines, and the second molars towards the end of the second year, so that by 2 and a half to 3 years most children have all 20 milk teeth. No teeth at 12 months is usually fine. No tooth by 18 months is worth mentioning to a doctor or dentist, and a baby born with a tooth needs a dentist to check it is firm.
Each tooth takes a few days to break through, while the drooling, chewing and grumpiness that parents call teething run for weeks around it, and much of that is a 6-month-old discovering hands, mouth and the world. Every 6-month-old drools. Tooth or no tooth.
What teething does cause
- More drool, and a red, chapped chin and neck from it.
- Chewing on everything, including you.
- A sore, red or swollen patch of gum where the tooth is coming. Sometimes a small bluish blister over the spot, which is harmless and breaks on its own.
- Rubbing the ear or cheek on that side.
- A grumpy day or two, a night or two of worse sleep, and a little less interest in solid food.
- A very slight rise in temperature, under 38 °C. Not a fever.
What teething does not cause
Track a baby day by day through a tooth coming and the pattern is the same: teething does not cause a true fever, diarrhoea, vomiting, a cough, a runny nose, a chest infection, a body rash, a nappy rash, or hours of inconsolable crying, and every one of those has another cause, usually the fact that the age at which teeth come is also the age at which the antibodies passed on from the mother fade and a baby starts putting germ-covered objects in the mouth all day. Infections and teeth arrive in the same season. One is not the other.
The reason this matters is that “it’s just the teeth” delays care. A fever of 38 °C or above is treated as a fever: at once in a baby under 3 months, and by the rules in our guide to a child’s fever by age after that. Loose stools are managed with ORS by the rules in loose motions in children by age, and watched for dehydration. An ear pulled at with a fever is an ear to be looked at. The tooth can wait; the infection cannot.
Safe relief, by age
Under 6 months
An early tooth is possible from 4 months, and relief is a clean finger rubbed on the gum, a chilled (not frozen) clean flannel, cuddles, and shorter, more frequent feeds. Nothing goes in the mouth except milk: no gels, no honey, no ghee on the gums, no herbal teething powders, no ghutti.
6 to 12 months
Teething rings chilled in the fridge, never the freezer, a clean cold flannel to chew, and cold soft foods once solids have started: chilled dahi, cold mashed banana, a chunk of cold cucumber held by you. Paracetamol at the weight-based dose, only for a genuinely miserable night, not routinely.
1 to 3 years
The molars come in this band and hurt more. The same cold things, plus a large piece of cold cucumber held by a parent for chewing, never left alone (raw carrot is a choking risk at this age), and the twice-daily brushing with a smear of fluoride toothpaste continues through molar days. Honey is allowed after 1 year in food; on the gums it is a sugar bath for new teeth.
3 to 6 years and over 6
The sore gums now are the first permanent molars at the back around age 6 and wobbly front teeth: cold drinks, soft food, salt-water rinses for a child who can spit, and a dentist if a gum is swollen with a fever.
- Wash your hands and rub the sore gum firmly with a clean fingertip for 1 to 2 minutes.
- Wet a clean muslin or flannel, wring it out, and put it in the fridge (not the freezer) for 30 minutes. Give it to the baby to chew, or hold a corner against the gum yourself.
- Chill a solid silicone or rubber teething ring in the fridge for 30 minutes, never the freezer, because a frozen ring burns the gums. Avoid liquid-filled rings, which can leak, and anything with small parts.
- For a baby over 6 months on solids, offer a spoon of dahi straight from the fridge, or a large chunk of cold cucumber held in your hand while the baby gnaws. You hold it; a baby left with a piece can choke. No raw carrot.
- Wipe the chin and neck folds dry every hour or so, with a thin smear of petroleum jelly on the chin to stop the drool rash and a dry cotton bib changed when wet.
- If the baby is clearly in pain and none of that settles them, give paracetamol at the dose for their weight from the pack or a pharmacist, and write down the time. Do not repeat it “for teething” for days on end; a baby needing pain relief for more than two days has something else going on.
- Brush the new tooth twice a day with a smear of fluoride toothpaste the size of a grain of rice, from the day it appears.
What not to use
- Teething gels with lidocaine or benzocaine. Benzocaine has caused a blood disorder in babies that turns the lips and skin blue-grey and starves the body of oxygen, lidocaine swallowed from the gums has caused fits and heart problems, and regulators in several countries have banned or restricted both for children under 2. The gel wears off in minutes anyway.
- Homeopathic teething tablets and powders. Some have been found to contain belladonna at unpredictable amounts and have been linked to fits and deaths in babies.
- Amber teething necklaces and bracelets. The amber does not release anything soothing, and babies have strangled on the necklace in cots and choked on the beads. Nothing goes around a baby’s neck, ever.
- Honey, ghee, brandy, whisky, sugar or gur rubbed on the gums. Honey is never given under 1 year because of botulism (our raw honey guide has the adult uses); alcohol is never given to a child; sugar and gur feed the bacteria that rot the new tooth.
- Clove oil, camphor, or any balm on the gums. Clove oil burns soft tissue and is toxic swallowed in quantity; camphor is unsafe for children in any form.
Teething was read as a dangerous passage, which is why so many charms attach to it: the taweez, the black thread, the copper ring, the honey rubbed on the gum “for strength,” and the fear made sense in a time when babies did die at that age, though of infections, not teeth. What survives usefully is the cold cloth, the clean finger, the cuddle and the patience. What goes is anything worn around the neck, anything rubbed into the mouth, and the idea that a fever can be ignored because a tooth is due.
The teething-and-infection trap
Because teeth and infections come at the same age, ask a different question: not “is it teething?” but “is this baby ill?” Thermometer, not hand. Count wet nappies. Look at the breathing. A baby who is drooling, chewing and cross but feeding, wetting nappies, smiling between grizzles and without a true fever is a teething baby, and a baby who is hot, off feeds, floppy, vomiting, breathing fast or passing watery stools is not, whatever the gums look like.
Doctor today
- Fever of 38 °C or above for more than a day in a baby over 3 months, or any fever over 39 °C with the baby unwell, or any fever past 3 days.
- Loose watery stools more than a few times, or vomiting.
- Refusing feeds for more than a few hours, or fewer wet nappies than usual.
- A gum that is very swollen, bleeding, or has pus, or a cheek that is swollen and hot.
- Rash anywhere except the drool-chapped chin.
- Crying that cannot be soothed for hours, or a baby who is unusually quiet.
- No teeth by 18 months, or a tooth that comes in grey, brown or crumbling.
Hospital now
- Any fever in a baby under 3 months.
- Breathing fast, chest sucking in, grunting, or blue or grey lips (also the sign of a benzocaine reaction if a gel has been used; bring the tube).
- A fit, a floppy or hard-to-wake baby, a rash that does not fade under a pressed glass, a stiff neck or bulging soft spot.
- No urine for 6 to 8 hours, no tears, sunken eyes or soft spot.
- A swallowed bead, a broken piece of teething ring, or a necklace found tangled: go, and bring what is left.
Never use teething gels containing lidocaine or benzocaine, homeopathic teething tablets, or anything containing camphor or clove oil in a child’s mouth. Never put a necklace, bracelet or anklet of any kind on a baby. No honey under 1 year, nothing but breast milk or formula in the mouth under 6 months, and no alcohol on the gums at any age. Fridge-cold, never frozen. Paracetamol is dosed by weight from the pack or by a pharmacist or doctor, not given routinely “for teething,” and never with another product that contains it; ibuprofen is a doctor’s or pharmacist’s call over 6 months in a baby who is drinking well; never aspirin under 16. A fever of 38 °C or more is an infection until a doctor says otherwise; treat it as a fever, and in a baby under 3 months go to hospital now.
Looking after the teeth that came
A milk tooth holds the space for the permanent one and can rot and hurt just like an adult tooth, so: fluoride toothpaste in a rice-grain smear from the first tooth and a pea-size amount from age 3, brushed by a parent until at least 7, no bottle in the cot and no milk or juice to fall asleep on, and a first dental visit by the first birthday. For the sore chin and neck that drool leaves, the barrier-cream method in our guide to nappy rash and baby skin works at the other end too. More on babies and toddlers is under Bachon Ki Sehat.
Does teething cause fever?
Not a true fever. A very slight rise under 38 °C is possible. 38 °C or above means an infection and is managed as a fever; in a baby under 3 months it is an emergency.
Does teething cause loose motions?
No. Babies at teething age put everything in the mouth and pick up stomach bugs. Treat the diarrhoea with ORS and watch for dehydration.
Can I use a teething gel to help my baby sleep?
Not one with lidocaine or benzocaine, and not the homeopathic tablets. They are unsafe in babies and wear off within minutes. A cold cloth, a finger on the gum and, on a bad night, weight-dosed paracetamol are the safe tools.
Are amber necklaces safe if I take it off at night?
No. Babies have strangled in daytime naps and choked on beads while awake. There is no soothing effect from the amber. Nothing goes around a baby’s neck.