Teething

Baby (primary) teeth first appear during the first 4 to 9 months of age. The first teeth to appear are usually the 2 bottom front teeth. The next to appear are the upper 4 front teeth. By the third birthday, most children have all their baby teeth (about 20 teeth). Starting around age 6 or 7, baby teeth begin to loosen and fall out. Adult (permanent) teeth grow in their place.

Symptoms

Most teething symptoms are often caused by the mild pain of tooth development. The classic symptoms linked to teething are drooling and putting fingers in the mouth. This is usually true. But, these may also just be signs of normal development. Common teething symptoms include:

  • Drooling

  • Redness around the mouth and chin

  • Irritability, fussiness, crying

  • Rubbing gums

  • Biting, chewing

  • Not wanting to eat

  • Sleep problems

  • Ear rubbing

  • Low-grade fever (below 100.4°F)

Home care

  • Wipe drool away from your baby's face often, so it does not cause a rash.

  • Offer a chilled teething ring. Keep these in the refrigerator, not the freezer. They should not be too cold.

  • Gently rub or massage your baby’s gums with a clean finger to ease symptoms.

  • Give your child a smooth, hard teething ring to bite on. Firm rubber is best. You can also offer a cool, wet washcloth. Don't give your baby anything he or she can swallow, such as beads.

  • Follow your healthcare provider’s instructions on using over-the-counter pain medicines such as acetaminophen for fever, fussiness, or discomfort. Don't give ibuprofen to children younger than 6 months old. Don’t give aspirin (or medicine that contains aspirin) to a child younger than age 19 unless directed by your child’s provider. Taking aspirin can put your child at risk for Reye syndrome. This is a rare but very serious disorder. It most often affects the brain and the liver.

  • Don't use numbing gels or liquids. These are medicines containing benzocaine. They may give short-term relief, but they can cause a rare but serious and possibly life-threatening illness.

Follow-up care

Follow up with your child’s healthcare provider, or as advised.

When to seek medical advice

Call the healthcare provider right away if:

  • Your child has a fever (see "Fever and children" below)

  • Your child has an earache (he or she pulls at the ear).

  • Your child has neck pain or stiffness, or headache.

  • Your child has a rash with fever.

  • Your child has frequent diarrhea or vomiting.

  • Your baby is fussy or cries and can't be soothed.

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant under 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider

  • Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead, or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider

  • Armpit (axillary) temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider

  • Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.

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