Overview

Teething is a normal phenomenon in a child’s development marked by the emergence of teeth. Many babies experience uncomfortable symptoms, like drooling, irritability and gum swelling during this time. Recognising this discomfort and differentiating it from other symptoms that may suggest potential health issues assists parents in understanding if their baby requires medical attention. In this article, the common symptoms are discussed, along with others that should not be confused with teething. Management options will also be highlighted so that parents can help their baby through this developmental stage.

Introduction

Teething Syndrome (or teething) is a natural developmental milestone all infants experience, with most children having their first tooth at 6 months of age. The 20 primary (or deciduous) teeth typically erupt by 30 months of age.¹ When a tooth begins to erupt or break through the gum line, the gums around it may cause tenderness and inflammation, leading to discomfort and pain.² In addition, increased salivation (sialorrhea) occurs, leading to drooling.³ Usually, the teeth emerge as follows:

It must be mentioned that every child experiences teething differently. For example, some children may demonstrate less discomfort than others.⁴ Moreover, some parents report that diarrhoea may also be caused, but there is no objective evidence that supports that.³

Common signs and symptoms

A great deal of studies support that there are no specific symptoms that can assist in the prediction of tooth emergence.¹ However, the most common symptomatology that has been observed during the teething phase includes:

Drooling

Excessive drooling or sialorrhea is one of the most common signs of teething.² If its presence is prolonged, it can lead to skin irritation or the appearance of a mild rash around the mouth, neck, cheek and chin (drool rash). Keeping the baby’s area as clean and dry as possible can help in managing this symptom.⁵ 

Irritability

Irritability and fussiness may not always be present, but are very common.³

Gum swelling

The gums may become erythematous (red) and swollen due to the inflammation that the emerging tooth can cause.

Other signs and symptoms

Other signs and symptoms that are commonly observed in Teething Syndrome include: 

• Disturbances in sleeping: the baby may be facing trouble sleeping² or not sleeping well⁴ due to waking up
• Biting and chewing: Babies will exhibit an increased need to bite or chew things (e.g. toys, their own hands) to relieve the pressure and discomfort induced on their gums⁵
• Low-grade fever: A slight increase in temperature (<100.4°F or <38°c) is not uncommon, but should the fever become too high, another underlying cause exists and should be further evaluated²
• Pulling or rubbing their ear or cheek: Babies usually show such behaviour because pain and discomfort can be felt on the cheeks and ears⁵

Symptoms that may be mistaken for teething syndrome

Symptomatology, which is commonly mistaken for Teething Syndrome, includes but is not limited to the following:

• Diarrhoea: current evidence supports that teething syndrome does not cause diarrhoea⁶
• Vomiting: It is not a symptom of teething, and care should be sought²
• High-grade fever: A high increase in temperature is not associated with teething, and medical attention must be sought in such cases. Delaying in seeking care can lead to delaying in appropriate treatment⁷
• Rash: contact a healthcare professional if you notice any abnormal rashes on your baby, as an underlying infection is possible
• Crying: Excessive crying can be a sign of other conditions, but it is not associated with teething (e.g. otitis media)⁷

Practical management options

As mentioned before, each child experiences teething differently. Various methods can be tried to determine which works best for your child. Some usual practical tips^8,9 are:

• Gum rubbing: With clean fingers, a wet washcloth or a moistened gauge, you can massage your baby’s gums for 2 minutes
• Teething rings and toys: cool rings, pacifiers, or wet washcloths can soothe the baby’s discomfort. Do not put them in the freezer, as gums can get damaged
• Pain relievers: Acetaminophen or ibuprofen can be used for up to 2 days if your baby is very fussy
• Cup feeding: Try feeding your baby by putting your breastmilk in a cup if there is resistance during breastfeeding
• Cold and soft foods: if your baby is able to chew, some soft fruit, bread crust or vegetables can ease the discomfort

FAQs

When should I start brushing my child’s teeth?

As soon as the first tooth emerges, you should start brushing twice daily. Contact your child’s dentist to discuss whether a fluoride toothpaste will be of any benefit. Brush gently with a small, bristled toothbrush. When your child learns how to spit, you should teach them how to brush and floss on their own while you supervise them.^2,8

Should I care for my child’s primary teeth?

Yes, because they play a crucial role in the development of many aspects of the oral and overall health of your child. Some of these concern the child’s face shape, nutritional status, speech and creation of a healthy space for the upcoming permanent teeth.²

When should I contact my healthcare provider?

If you notice any symptoms in your child that appear concerning, such as high fever, vomiting, or a rash, contact a healthcare professional.^2,4 Spotting atypical symptoms early is important as misdiagnosis can be avoided, and early care can be provided.¹

What should I avoid doing when my baby is teething?

Avoid homoeopathic teething tablets and gels as they have not been proven to assist babies, and they contain higher amounts of Atropa belladonna, an ingredient that can cause breathing issues as well as seizures.¹⁰ In addition, topical pain relievers that contain lidocaine or benzocaine must be avoided as they can harm your child. Lastly, items such as bracelets and necklaces should be avoided as they can increase the risk of choking and other injuries.^8,11 Always be alert for potential choking hazards. 

Summary

Teething Syndrome, or teething, is a natural developmental process where an infant’s teeth erupt most typically from 6 to 30 months of age. Teething can be different for every child, but the most common symptoms include drooling, irritability, gum swelling, sleep disturbances, biting/chewing objects, low-grade fever, as well as ear/cheek pulling or rubbing. Symptoms unrelated to teething include diarrhoea, vomiting, high-grade fever, excessive crying and rash. Common management practical tips include gum rubbing, teething rings/toys, pain relievers, and cold and soft foods. Homoeopathic teething tablets, gels containing lidocaine/benzocaine and jewellery should be avoided due to choking hazards and a high risk of other injuries.