What is teething?

Teething is the normal process of new teeth working their way through the gums. Your baby's first tooth may appear any time between the time he is 3 months to 1 year old. Most children will have all 20 of their baby teeth by the age of 3.

Most children have completely painless teething. The only symptoms are increased saliva, drooling, and a desire to chew on things. Teething occasionally causes some mild gum pain, but it doesn't interfere with sleep. The degree of discomfort varies from child to child. Your child won't be miserable. When the back teeth (molars) come through (age 6 to 12 years), the overlying gum may become bruised and swollen. This is harmless and temporary.

Because teeth erupt almost continuously from 6 months to 2 years of age, many unrelated illnesses are blamed on teething. Fevers are also common during this time because after the age of 6 months, infants lose the natural protection provided by their mothers' antibodies.

Which baby teeth come in first?

Your baby's teeth will usually erupt in the following order:

1. 2 lower inner incisors (bottom front teeth)
2. 4 upper incisors (top front teeth)
3. 2 lower outer incisors and all 4 first molars
4. 4 canines
5. 4 second molars.

How can I take care of my child?

• Gum massage

  Find the irritated or swollen gum. Massage it with your finger for 2 minutes. Do this as often as necessary. You may also massage the gum with a piece of ice.

• Teething rings

  Your baby's way of massaging his gums is to chew on a smooth, hard object. Teethers or teething rings are helpful. Most children like them cold. Offer a teething ring that has been chilled in the refrigerator, but not frozen in the freezer. A piece of chilled banana may help. Avoid ice or Popsicles that could cause frostbite of the gums. Also avoid hard foods that he might choke on (like raw carrots). Teething biscuits are fine.

• Diet

  Avoid salty or acid foods. Your baby probably will enjoy sucking on a nipple, but if he finds this uncomfortable, use a cup for fluids temporarily.

• Pain medicine

  If the pain increases, give acetaminophen (Tylenol) for 1 day. Special teething gels are not necessary and probably not beneficial. Many teething gels contain benzocaine, which can cause an allergic reaction. In addition it's unlikely they can numb the gums because they are washed out of the mouth and swallowed within a few minutes. If you still want to use a gel, do not apply it more than 4 times a day.

• Common myths about teething
  • Teething does not cause fever, sleep problems, diarrhea, diaper rash, or lowered resistance to any infection. It probably doesn't cause crying. If your baby develops fever while teething, the fever is caused by something else.
  • Don't tie a teething ring around your baby's neck. It could catch on something and strangle your child. Attach it to your baby's clothing with a "catch-it-clip."

When should I call my child's healthcare provider?

Call during office hours if:

• Your child develops a fever over 101°F, or 38.3°C.
• Your child develops crying that doesn't have a cause.
• You have other questions or concerns.