Teething, the growth of a baby’s milk teeth through their gums, is a milestone every baby experiences. Although some babies have their teeth emerge with little to no difficulties, others experience discomfort and behavioural changes as their milk teeth grow into place. Teething symptoms may cause undue worry for new parents regarding their child’s health. At the same time, it is easy to mistake genuine signs of illness for teething symptoms. To increase understanding of this momentous milestone, this article explores the questions: what are some common symptoms of teething and illness, and how does one differentiate between the two?

What is teething?

Teething is the process by which milk teeth grow through a baby’s gums. This process usually starts when a baby is around 6 months old, although it can begin as early as 3 months or as late as 12 months. Some babies are even born with their first few teeth already grown in! Most children have all their milk teeth grown by age 3. At this point, toddlers are typically able to communicate their discomfort as their milk teeth break through their gums. However, babies who have just begun teething are rarely able to express their discomfort, leaving parents to guess whether their child is simply teething or fallen ill.

Symptoms of teething vary from child to child. While some babies have their teeth emerge with no discomfort, others may experience pain during teething, which may affect their mood and behaviour. Symptoms of teething and illness can appear similar, causing parents to worry about their child’s health. To better differentiate between the two, we must first answer the question: What are some teething symptoms to watch out for?

Symptoms of teething

Some babies only show signs of teething when their first tooth grows in. Others may experience pain and discomfort as their milk teeth break through their gums. The following symptoms are often associated with teething:

• Irritability 
• Drooling
• Chewing on objects
• Swollen gums
• Pulling on ears
• High body temperature

Irritability 

Teething may be painful for some children, causing them to be more irritable than usual. They may refuse to eat due to the pain, leading to an apparent loss of appetite. Due to the discomfort of teething, some babies may have trouble sleeping. They may wake up more frequently at night or refuse to take naps during the day. Refusal to eat may also cause young children to wake up at night as they feel hungry.

Drooling 

During teething, babies may experience an increased flow of saliva, causing them to drool more than usual. Accumulation of drool on the baby’s face may also lead to the development of rashes; thus, the child’s face should be wiped regularly.¹

Chewing on objects

Babies may chew on solid objects in an attempt to soothe their pain, as the gentle pressure provides relief to sore gums. This may include their toys, clothing, or even their fingers. Providing the baby with teething rings may help redirect this behaviour. 

Swollen gums

The baby’s gums may be red and swollen around the area where their first milk tooth is pushing through. 

Pulling on ears

Pain in the gums can travel through the cheeks and eardrums, causing babies to pull on their ears to alleviate the pain.

High body temperature

Milk teeth pushing through the gums causes irritation, giving babies flushed cheeks and slightly elevated body temperature. However, the baby’s temperature should remain below 38°C. If the baby’s temperature is above the fever threshold of 38°C, that is not a teething symptom but instead a sign of illness.

Common illnesses in young children

Symptoms of teething may be mistaken as signs of illness, but more dangerously, signs of illness may be dismissed as teething symptoms. The following are some common illnesses in young children with symptoms that can be confused with teething:

• Respiratory infections
• Gastrointestinal infections
• Ear infections

Respiratory infections

Respiratory tract infections occur when the body’s respiratory system becomes infected, including the throat, airways, and lungs. They are common in young children, with children developing on average six respiratory tract infections per year.² Some examples of common respiratory infections in children include the common cold, influenza (more commonly known as the flu), and bronchiolitis (chest infection common in children younger than 2). Symptoms vary between strains and diseases, with some common symptoms being:

• Coughs
• Runny nose
• Nasal congestion (a blocked nose)
• Sore throat
• Loss of appetite
• Fever

Gastrointestinal infections

Stomach bug is a general term for any germ that infects the stomach and intestines. Among them are gastroenteritis (more commonly known as the stomach flu) and norovirus (also known as the winter vomiting bug). When a child has a stomach bug, they may present the following symptoms:

• Diarrhea
• Vomiting
• Loss of appetite
• Fever

Ear infections

Ear infections, also known as acute otitis media, occur when the middle ear becomes inflamed. The middle ear is an air-filled chamber between the eardrum and inner ear, containing three small bones for transmitting sound vibrations from the eardrum to the inner ear and beyond. It is kept dry by the eustachian tubes, which keep the air pressure inside the ear constant and drain fluids from the middle ear. As the eustachian tubes of young children are smaller and more horizontal, they are less able to drain fluids from the middle ear. This causes a buildup of fluids, providing an ideal environment for bacteria and viruses to develop. As young children’s immune systems are still developing, they are less able to fight off the germs growing in their fluid-filled ears, resulting in an ear infection. That is why ear infections occur most often in children 6 months to 2 years old.³

Children are particularly susceptible to ear infections during and after respiratory tract infections. The eustachian tubes drain fluids and keep ear pressure constant by connecting the middle ear to the back of the throat. During respiratory infections, the throat and eustachian tubes often become swollen, preventing the effective drainage of fluids from the middle ear. The fluids accumulate in the middle ear more easily, increasing the risk of pathogen growth, resulting in ear infection. Common signs of ear infection include:

• Pulling on ears
• Drainage of fluids from the ears
• Loss of appetite
• Fever

Differentiating teething & illness symptoms

Overlapping symptoms

Symptoms of teething and illness often appear similar. In young children unable to express their discomfort in words, parents may worry whether their child is teething or sick. The following are some overlapping symptoms between teething and illness:

• Irritability 
• Loss of appetite
• Pulling on ears 

Irritability

Many people, not only children, feel irritable when they are in pain. However, when children are sick, they are often fussier and more prone to crying than if they are simply teething.

Loss of appetite

When babies are teething, they often seem less hungry or refuse to feed due to the pain in their gums. In these cases, soothing their pain by rubbing their gums with a damp cloth or clean finger may help soothe their pain. 

In contrast, loss of appetite during illness is an attempt by the immune system to fight the pathogens. The infected tissue communicates the pathogen invasion to the central nervous system, which tells the body to release cytokines, signalling chemicals that coordinate a defense against the inflammation. One of the effects of cytokines on the body includes a decrease in appetite.⁴

Pulling on ears

Babies may pull on their ears when they are teething or suffering from an ear infection. When teething, pain from the baby’s gums may radiate up their cheeks and ears. During an ear infection, babies may also experience pain in their ears. Tugging on their ears helps to alleviate the pain. 

Commonly mistaken symptoms

The above symptoms form an overlap between teething and sickness. Meanwhile, the following signs of illness are often mistaken for teething symptoms:

• Fever
• Diarrhea & vomiting 

Fever

While teething may cause a rise in body temperature due to the irritation of the gums, it does not cause a fever of 38°C or above. Cytokines released after infection induce a rise in temperature as part of the body’s immune response, causing a fever.⁴ When a child’s body temperature rises above 38°C, they are likely to be sick.

Diarrhoea & vomiting

Although teething causes an increase in saliva production, it does not cause the child to vomit or have diarrhoea.¹ If a teething child has vomit or diarrhea, it may be a sign of illness. 

While it may be difficult to differentiate between teething symptoms and signs of illness, a combination of the above symptoms increases the likelihood that your child is suffering from an illness. This is particularly true if your child was recently exposed to a daycare or another environment in which they are likely to catch a bug. If you are unsure whether your baby is teething or sick, the safer option may be to consult your pediatrician for advice.

Summary

Teething, the growth of a child’s milk teeth through their gums, is a milestone in every child’s development. Symptoms of teething vary, with some children showing little to no symptoms, while others experience visible discomfort as their milk teeth emerge. There is a small overlap between teething symptoms and signs of illness, including a child’s displays of irritability, a loss of appetite, and pulling on their ears. Other signs of illness, including fever, diarrhea and vomiting, are also often mistaken for teething symptoms. It is important to distinguish between teething symptoms and signs of illness for the child’s health. If you are worried about your child’s health, it may be beneficial to consult a pediatrician for advice.