Teething

What is teething?

Teething is a normal part of growing for babies: it's when the baby teeth push through the gums as they're growing.

Although the milk teeth develop when the baby is growing in the womb, babies are not born with their first teeth. The teeth only start to grow throughout the gums when the baby is 6-9 months old (although it can be before or after these ages). When the teeth grow, special chemicals are released by the body, which causes part of the gums to separate and so allows the teeth to grow through.

The teeth grow throughout the gums in stages. Usually the lower front teeth come through first, followed by the top middle teeth. Other teeth follow over the following months. A child is usually aged around 2½ or 3 years when they have their full set of first teeth.

When do babies start teething?

It usually happens at 6-9 months of age. Your baby may be more unsettled than usual, dribbling or want to chew on something more than usual.

Teething symptoms

Symptoms of teething often occur a few days (or even weeks) before the tooth comes through the gum. Common signs and symptoms include:

• Red and swollen gums.

• Red flushed cheek or face.

• Rubbing their ears on the same side as the tooth which is coming through.

• Dribbling more than usual.

• Waking more at night and generally being more unsettled.

• Inconsistent feeding.

• Rubbing their gums, biting, chewing or sucking more.

Babies and children can vary greatly with the symptoms they can have when they are teething. For many babies, teething leads to mild symptoms that just last a few days. However, for others, teething is painful and can last much longer.

Although there is little evidence that diarrhoea is caused by teething, there often seems to be a change in the poo (stools) at this time - they become slightly looser. A very mild rise in temperature may possibly be a symptom of teething, but a temperature of 38°C or higher should not be put down to teething.

Teething should not cause your child to become unwell. If your baby or child has a fever of 38°C or higher, diarrhoea or other symptoms and is unwell then you should see your doctor to check for another cause of their symptoms, or manage it over the counter if you are happy to do so (eg, using paracetamol to treat a cold). Examples of other causes of a child being unwell or developing a fever include an ear infection, chest infection or urinary infection.

Treatment for teething

Many babies and children will have minimal or no symptoms when they are teething so will not need any treatment.

However, the following may be useful for those who are having symptoms:

General advice

Gently rubbing over the affected gum with your clean finger may ease the pain. Many children find that biting on a clean and cool object is soothing (for example, a chilled teething ring or a clean, cold, wet flannel). Chewing on chilled fruit or vegetables may help. However, teething biscuits (or rusks) should be avoided as they contain sugar.

Medicine to help the pain

If your child is in pain or discomfort with their teething, then giving a pain reliever such as paracetamol or ibuprofen may help. These should be given at the recommended doses for their age.

There is no evidence that complementary treatments are of any benefit for teething - for example, herbal teething powder.

Teething gels

There are teething gels available which contain a local anaesthetic or mild antiseptic (for example, Bonjela® or Calgel®). The local anaesthetic is usually lidocaine. Experts advise against using these gels for teething pain. This is because there is not much evidence that they help for very long and there is evidence that they can cause harm.

There have been a number of cases where a baby has accidentally swallowed too much of the anaesthetic and had serious consequences, including death. If you do choose to use a teething gel, follow the manufacturer's instructions closely to be sure it is safe.

There is no evidence that using gels which contain choline salicylate is of any benefit for teething. In addition, there is a risk of the salicylate leading to a liver condition, called Reye's syndrome, in children (aged under 16 years). So, gels which contain choline salicylate should also be avoided.