Teething and Your Baby

Every child will experience teething at some stage, but the fact that it is a natural and universal stage of development does not mean that it is always easy and pain-free. In the article below we take a look at what teething is, the symptoms, and how you can help to manage it so that your child does not suffer any more pain and discomfort than necessary.

What is teething?

Teething is what happens when a baby’s first teeth push through her gums. It can be a frustrating time for babies and their parents. However, it can help to know what to expect during teething and how to manage the symptoms.

At what age do babies start teething?

According to the NHS, some babies already have teeth when they are born, while NICE reports that 1% of babies may begin teething in the first four months of life. However, most babies begin teething around 6-9 months with a further 1% not beginning until they are twelve months old.(1)

But your child’s teeth do not need to be showing for the symptoms of teething to begin; in fact, these symptoms can arrive several months before the teeth push through.

Which teeth appear first?

Teeth often arrive in pairs, with the bottom incisors (bottom two front teeth) usually the first to emerge. By the time a child is three, they will usually have a full set of teeth.

Teeth usually (although not always) appear in the following order (2):

Bottom incisors (bottom front teeth): typically come through at 5-7 months.
Top incisors (top front teeth): typically 6-8 months.
Top lateral incisors (the teeth on either side of the top incisors): typically 9-11 months.
Bottom lateral incisors (either side of the bottom incisors): typically at 10-12 months.
First molars (back teeth): typically 12-16 months.
Canines (towards the back of the mouth): typically 16-20 months.
Second molars: typically 20-30 months.

What are the symptoms of teething

Not all children will show symptoms of teething or appear to suffer. However, others may become irritable with pain and discomfort. Possible symptoms of teething include:

Red cheeks
Dribbling and drooling
Ear rubbing
Gum rubbing
A facial rash
Irritability
Decreased appetite
Wakefulness and/or disturbed sleep
Persistent chewing

Some people claim that teething may cause diarrhoea and fever, however, the NHS says that such claims are not supported by any evidence, although NICE says that it may cause pyrexia “mild fever”. (1,2)

As such, there is clearly room for further investigation in this area. For example, according to one 2011 study(3), the rate of teething symptoms can be broken down as follows:

No symptoms: 38%
Fever: 16%
Fever-drooling: 15%
Fever: 8%
Fever-diarrhoea: 8%
Drooling-diarrhoea: 6%
Fever-drooling-diarrhoea: 3%

It is interesting to note that the study found a higher incidence of teething symptoms among babies and younger children, with children aged 2-3 experiencing a lower incidence and intensity of symptoms.

However, the fact is that the study did not seek to evaluate either irritability or irritation of the gums. This is because these symptoms are quite subjective and are therefore hard to quantify.

Tips to soothe teething pains

There are various steps you can take which may prove effective in relieving some of the symptoms of teething. Proven methods include:

Gently rubbing the gum with a clean finger (you may see your baby already doing this, although perhaps not always with a clean finger!).
Biting on a clean, cool object such as a teething ring.
Wiping excess saliva from the face to prevent the development or worsening of a facial rash.
Reassurance, cuddling, and distraction to comfort your child.

What about over-the-counter pain relief for teething?

NICE and the NHS recommend that it is safe to use sugar-free over-the-counter paracetamol and/or ibuprofen if self-care measures are not providing sufficient relief and your child is three months or older.

Are teething gels effective?

Both NICE and the NHS advise that there is no evidence indicating the efficacy of teething gels(1,2). Furthermore, some teething gels may even be harmful – this includes homeopathic gels; NICE says that a number of unlicensed homeopathic teething gels have been linked to serious side effects. As such, if you do use a teething gel be sure that it is licensed for use in babies by the Medicines and Healthcare products Regulatory Agency (MHRA).

When to seek help with teething symptoms

Most teething will not cause more than mild symptoms. However, you should contact your GP if:

Your child has a fever: over 38 ˚C (100.4 ˚F) in babies under three months and over 38.8 ˚C (102 ˚F) in babies older than three months
Your child’s mild fever symptoms last longer than 24 hours
Your child has diarrhoea, vomiting or a rash with fever
Your child becomes very sleepy or looks ill
Your child is crying more than usual and can’t be soothed

Summary

Teething is part of life for all of us. However, given that it involves the emergence of bone through the soft and tender gums of the mouth, it can be understandably painful for some (although not all) babies. Fortunately, there are things that you can do to help your child manage some of the symptoms of teething, but be wary of ignoring serious symptoms that could be something else.

1. https://cks.nice.org.uk/topics/teething/
2. https://www.nhs.uk/conditions/pregnancy-and-baby/teething-and-tooth-care/
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476083/