Some babies are born with "natal" teeth but often these fall out and new teeth take their place as the child gets older, according to Carrie M. Brown, M.D., a pediatrician in Little Rock, Arkansas. Babies start showing signs of teething around 4-6 months: producing more saliva and putting their fingers in their mouths. (The drooling is usually unrelated to teething and stops once teeth come in; they help to dam up the drool so it gets swallowed.)
Infants typically get their first tooth between ages 5 and 12 months, but some take longer. The bottom incisors emerge first, followed by the top incisors. A toddler usually has a full set of teeth by around 2 years of age, explains Edward Kulich, M.D., of New York, NY. Any child who is without teeth by then should see a pediatrician, who may recommend a dental visit with X-rays. There are a few very rare medical conditions where the body fails to form teeth.
Parents know firsthand that teething can make a baby cranky and even cause a mild fever. However, any temperature above 101 degrees is likely from an infection rather than teething.
"If an infant has a temperature, excessive irritability, decreased eating, increased sleeping, or other symptoms such as vomiting, a cough, or a rash, it is unlikely that teething is the culprit," says Dr. Kulich. "If your infant is experiencing such symptoms, or the irritability is excessive, you should touch base with your pediatrician."
The average age when babies start teething is about 6 months. At this time your little one may begin to refuse to eat solid foods, instead preferring to chew on things. If she's also drooling a lot, teething may be the issue. Check in the mouth to be sure there are no white spots, which could indicate thrush—an overgrowth of yeast in the mouth that requires a trip to the doctor, says Dr. Brown.
Otherwise, continue to offer solids once a day and try different textures of foods and types of spoons (those with a coating like a teething ring may be preferable to her). If you go more than 3 to 4 weeks without success or if at any time she starts refusing liquids a visit to her doctor is recommended.
Many parents notice an increase in teething symptoms and discomfort during evening hours, but there's no specific medical reason for this. "It seems worse at night because they are tired, and during the day they are awake and playing and have things to distract them from the pain," says Gaurav Gupta, M.D., pediatrics expert at JustAnswer.com.
If your little one drools so much that the constant contact with saliva is irritating his lips and skin, there are things you can do to help soothe him. "Apply some Vaseline (white petroleum jelly) to reduce the contact of the saliva with the tender skin. Also, do not rub the saliva off the chin—just pat-dry gently to avoid a friction-induced, worsening rash," Dr. Gupta says.
Ouch! Teething can be uncomfortable as little teeth poke their way through sensitive gums. "I recommend giving an appropriate dose of acetaminophen along with a cool teething ring," says Tanya Remer Altmann, M.D., of Los Angeles, co-editor of Caring for Your Baby and Young Child. "Popsicles work well for toddlers and are a fun treat!
"For infants over 6 months of age, an appropriate amount of acetaminophen or ibuprofen can be used as needed for pain. Which one? Whichever you have in your medicine cabinet or whichever your child prefers since most uncomfortable toddlers seem to have a preference for flavor."
There haven't been many studies on what remedies (natural or otherwise) are truly effective for the pain associated with teething, says Michael McKenna, M.D., a pediatrician at Indiana University School of Medicine. "For most infants, nonmedicinal therapies such as chewing on cool washcloths, frozen teething rings, and other such items is usually enough to ease the pain. If you feel your baby needs something more, acetaminophen usually does the trick, and if it doesn't you should discuss with your doctor—something more than teething may be going on."
Never give your infant alcohol of any kind, even topically. Also, while some people tout the benefits of clove oil, it can burn your baby's gums and skin, so avoid this as well.
"Teething fever" is a surprisingly controversial topic. "Recent research points seem to confirm that some symptoms, including fever around 101 degrees Fahrenheit, may be associated with teething," Dr. Michael McKenna says. "However, it is important to note that there was no association with high fevers (those greater than 102 degrees Fahrenheit), and that around a third of teething infants had no symptoms. Whether your child is teething, it is still a good idea to call your child's doctor for further advice."
Once your baby's first tooth appears, gently wipe it off twice a day with a soft cloth or infant toothbrush, recommends Dr. Altmann. "You do not need toothpaste at this stage. Around 1 year of age, gently brush your child's teeth with a soft toothbrush and a tiny bit of nonfluoride toothpaste. Some pediatric dentists may recommend a tiny amount of fluoride toothpaste for some toddlers. Around age 1 is also a good time to check in with a pediatric dentist."