Teething

Teething is a normal part of a baby's first two or three years, and it varies enormously. Some babies cut every tooth without their parents noticing. Others are sore, fretful and difficult to settle for a few days around each one. Neither pattern means anything is wrong.

Most of the distress is short-lived and responds to simple comfort. The reason teething deserves a careful article is not that it is dangerous, but that the remedies sold for it include several that are, and that attributing a genuine illness to teething can delay the care a baby needs.

When teeth arrive

Most babies cut their first tooth at around six months, though anywhere between three and twelve months is ordinary, and a few babies are born with one. The two lower front teeth usually come first, followed by the two upper front teeth. There are twenty first teeth in all, and most babies follow roughly the same order, with the second molars last to arrive somewhere between two and three years of age.

A baby with no teeth at all by about a year is worth mentioning at a routine check, but it is far more often a matter of timing than a sign of a problem.

What teething actually does

The gum over an erupting tooth becomes sore and sometimes red or slightly swollen. Around that, the familiar cluster: a great deal more dribbling than usual, a strong urge to chew and bite, one flushed cheek, rubbing at an ear or the side of the face, broken sleep and general fretfulness. Constant dribble can leave a mild rash on the chin and neck. Some babies run a slightly raised temperature.

What teething does not do

This is the more useful half of the subject. There is no good evidence that teething causes diarrhoea, vomiting, a high fever, a cough, a rash beyond the dribble rash, or a baby who is genuinely unwell rather than simply miserable.

Because teeth arrive during the same months that a baby's inherited immunity fades and infections start, the two coincide constantly, and the coincidence has been mistaken for cause for as long as anyone has written about babies. The practical consequence matters: a baby who is listless, feeding poorly, hot, or not themselves in a way that worries the people who know them is ill, and needs assessing for that illness. Teething is never the explanation for a sick baby.

What helps

Something firm to chew. Pressure on the gum is genuinely soothing, and it gives a baby something to do with the urge to bite. A solid teething ring is the simplest option, and many can be cooled in the fridge, which helps further. They should not be put in the freezer: frozen solid, a ring is hard enough to bruise the gum it is meant to relieve. Nothing should ever be tied round a baby's neck to keep it to hand.

Gum massage. Rubbing the sore gum gently with a clean finger works as well as most things sold for the purpose, and costs nothing.

Something to gnaw, from six months. Once a baby is taking solid food, a piece of soft ripe fruit or well-cooked vegetable gives the same pressure with something to taste. It needs watching the whole time, and anything that could break off into a lump that fits a windpipe is not suitable.

Comfort and distraction. Attention makes pain easier to bear at any age, and a baby who is absorbed in something is not thinking about their gums. Wiping the chin regularly and keeping the skin dry prevents most dribble rash; a plain barrier cream helps where it has already started.

Pain relief, where comfort is not enough. Sugar-free infant paracetamol can be given from two months, and infant ibuprofen from three months provided the baby weighs more than five kilograms. The dose goes by the label and by age and weight, not by how distressed the baby seems, and a pharmacist will confirm it. Aspirin must never be given to anyone under sixteen.

Teething gels

The evidence that they help is weak. When the medicines regulator reviewed teething gels containing the local anaesthetic lidocaine, it found no evidence that they worked better than non-medicinal measures, and restricted their sale to pharmacies, with advice that they be used only as a second line of treatment where simpler measures have not given relief. Anything applied to the gum is also largely washed away by the dribbling that prompted it.

Where a gel is used, it should be one made for babies and sugar-free, applied as the instructions direct. Gels and ointments intended for adult mouth ulcers or toothache are not suitable for infants.

What to avoid

Homeopathic teething tablets, granules and gels. Many contain belladonna, which is deadly nightshade. When the United States regulator tested these products it found amounts of the toxin varying unpredictably from the labelled quantity, and the products were linked to reports of seizures and infant deaths before being withdrawn from sale. UK guidance does not recommend homeopathic teething products. There is no version of this that is worth the risk to a baby for a complaint that resolves on its own.

Clove oil and other essential oils rubbed into the gums. Clove oil is an irritant in undiluted form and is not suitable for an infant's mouth at any dilution a parent can judge at home. It has no place in teething care.

Amber and beaded teething necklaces, bracelets and anklets. The claim behind amber is that body heat releases a pain-relieving substance absorbed through the skin, and there is nothing to support it. The risks are concrete: a regulatory safety warning on teething jewellery records an eighteen-month-old strangled by an amber necklace during a nap, and reports of children choking on beads that worked loose. Suffocation is the leading cause of death in babies under one, and nothing should be worn round a baby's neck. Jewellery sold for teething is not an exception.

Rusks, teething biscuits and anything sweetened. A baby's first teeth can decay from the moment they appear, and a sweetened biscuit held in the mouth for comfort is close to the worst case. The same applies to fruit juice, squash and sweetened milk in a bottle, and to dipping a dummy in anything at all.

Hard food and anything that breaks into pieces. Raw carrot, apple, ice and frozen fruit all pose a choking risk to a baby who has teeth enough to bite a piece off and not enough to chew it.

Once the teeth are through

Brushing starts with the first tooth, not with the first full set: twice a day, with a smear of fluoride toothpaste on a small soft brush, including last thing before bed. Cleaning around a sore erupting gum can be done gently with a soft cloth until the brush is tolerated again.

The first dental visit belongs in the first year, as soon as teeth start to appear, and NHS dental care is free for children. Dental care for babies covers brushing, first visits and preventing early decay in more detail.