TEETHING IN BABIES: SYMPTOMS – WHAT’S NORMAL VS NOT

Teething in babies is a normal developmental milestone, but it is also one of the most misunderstood stages in early childhood.

In primary health care settings, parents frequently present with concerns such as fever, persistent crying, poor feeding, diarrhoea, or sleep disturbance, and assume teething is the cause.

From a clinical nursing perspective, this is where confusion often occurs.

While teething can cause mild discomfort, it does not explain many of the symptoms commonly blamed on it, especially high fever or persistent illness.

This guide explains teething in babies, symptoms, what is normal, and when symptoms may indicate something more serious.

When does teething start in babies?

Teething usually begins between 4 and 7 months of age, but there is a wide normal range.

Some babies may start as early as 3 months, while others may not begin until 12 months or later.

The first teeth to appear are usually the lower front teeth, followed by the upper front teeth.

Between the ages of 2 and 3 years, most children have a full set of 20 primary teeth.

Normal teething symptoms in babies (what parents typically notice)

These are mild, short-term, and non-dangerous symptoms:

• Increased drooling
• Chewing on hands, toys, or objects
• Mild gum swelling or tenderness
• Mild irritability or clinginess
• Slight sleep disturbance
• Mild feeding changes

Key pattern: symptoms are intermittent, and the baby is otherwise generally well.

What teething does NOT usually cause (important myth-busting)

Teething is often incorrectly blamed for illness.

It does NOT usually cause the following:

• High fever
• Persistent diarrhoea
• Vomiting
• Chest infections
• Severe lethargy
• Continuous crying with illness signs

If these occur, do not assume teething is the cause.

Teething vs fever: how to tell the difference

A temperature above 38°C is NOT caused by teething alone.

Teething may cause slight temperature changes due to gum inflammation, but it does not cause a true fever.

Seek medical advice if:

• Fever is above 38°C
• Fever lasts longer than 24–48 hours
• Fever occurs with vomiting, rash, or poor feeding

Important: teething and illness can occur at the same time.

Can teething cause diarrhoea?

Teething does not directly cause diarrhoea.

Some babies may have slightly looser stools due to increased saliva swallowing.

However:

• True diarrhoea (frequent watery stools) is not caused by teething
• Persistent diarrhoea may indicate infection or dehydration risk

Why do babies sleep poorly during teething

Sleep disturbance is one of the most common parental concerns.

This happens because of the following:

• Gum pain is more noticeable at night
• Fewer distractions during sleep
• Increased need for comfort feeding

This phase is temporary and improves once the tooth erupts.

Safe ways to soothe teething symptoms

Safe, evidence-based comfort measures include:

• Chilled (not frozen) teething rings
• Clean cold washcloth for chewing
• Gentle gum massage with a clean finger
• Extra comfort and cuddling
• Comfort feeding if needed

Avoid:

• Alcohol-based teething gels
• Amber teething necklaces (choking risk)
• Frozen hard objects (gum injury risk)
• Unregulated herbal remedies

When teething is NOT the cause (red flags)

Seek medical care if the baby has:

• Fever above 38°C
• Poor feeding or refusal to feed
• Signs of dehydration (dry mouth, fewer wet nappies)
• Persistent vomiting or diarrhoea
• Unusual sleepiness or lethargy
• Breathing difficulty
• Rash with fever

These symptoms require assessment, not reassurance as “just teething”.

Teething timeline (what to expect)

Most babies start teething between 4 and 7 months of age, when the lower front teeth usually appear first. Between 8 and 12 months, the upper front teeth typically come through. From 12 to 18 months, the first molars begin to erupt, followed by the canines between 18 and 24 months. Between the ages of 2 and 3 years, most children will have a full set of 20 primary (baby) teeth. 

 Nurse’s clinical perspective

From a PHC nursing perspective, teething is often overattributed as a cause of illness.

A key clinical rule is the following:

Teething may explain discomfort, but it should not explain a sick baby.

An alert baby who is feeding reasonably well and having mild intermittent symptoms is usually experiencing normal teething.

However, systemic symptoms always require further assessment.

 Frequently Asked Questions

Can teething cause fever in babies?

Teething does not cause a fever above 38°C. A true fever usually indicates illness.

Can teething cause diarrhoea?

No. Mild changes in stool may occur, but true diarrhoea is not caused by teething.

How long does teething last?

Each tooth may cause mild symptoms for a few days before and after eruption.

At what age is teething worst?

Most babies are more unsettled during the eruption of the first teeth (4–12 months).

Final Word

Teething is a normal developmental stage, but it is often incorrectly blamed for symptoms caused by illness.

A simple clinical rule for parents:

• Mild discomfort may be teething
• A very unwell baby is NOT teething

When in doubt, always assess the full symptom picture rather than one isolated sign.

If you found this post helpful, you might also like:

Teething and Breastfeeding: Why Babies Bite, Feed Less, and Refuse the Breast

Baby Symptoms Guide: What’s Normal & When to Worry (A Nurse’s Guide for Parents)

Baby Not Feeding Well: What It Really Means and When to Worry

Child Fever: What Is Normal and What Isn’t

Baby Health Checklist: What’s Normal in the First 12 Months