Teething and eating: sore gums at mealtimes

When teething happens

Most babies get their first tooth at around 6 months, usually the bottom front teeth (NHS, AAP). It varies a lot: some start before 4 months and some after 12 months (NHS), and the AAP says babies may feel discomfort weeks or months before a tooth appears. Most children have all 20 baby teeth by 2 to 3 years (NHS).

That means teething often overlaps with starting solids, and it carries on through the toddler years as the back teeth come through.

Normal teething signs

Some teeth come through with no fuss at all. When teething does bother a baby, you may notice (NHS, AAP):

• sore, red gums where the tooth is coming through
• more dribbling (drool) than usual, sometimes with a rash around the mouth or on the face
• chewing on fingers, toys and anything they can grab
• one flushed cheek, or rubbing an ear
• being more fretful than usual, or sleeping less well
• a temperature that’s slightly raised but under 38°C (100.4°F) (NHS)

How teething can affect eating

An NHS team lists a smaller appetite among the usual teething signs, along with disturbed sleep (NHS Black Country). Sore gums can make chewing and sucking uncomfortable for a few days.

• It’s usually short-lived. Teething symptoms tend to be mild and last a few days (NHS).
• Keep offering milk feeds and meals as usual, and let your baby decide how much to eat. A few lighter days won’t harm a baby who is otherwise well. See hunger and fullness cues.
• Don’t add sugar or switch to sweet snacks to tempt them. Sugar causes tooth decay, even with only a few teeth (NHS).
• If your baby stops feeding or won’t drink, or seems unwell, it’s probably not just teething. See “When it isn’t teething” below.

Cold foods and other ways to soothe sore gums

Something cool to chew on can help.

• A chilled teething ring. Cool it in the fridge, following the instructions. Never put it in the freezer: something frozen solid can hurt your baby’s gums (NHS, FDA). Choose a firm one, not liquid-filled, because those can leak or break (AAP, FDA).
• A clean, cold, wet washcloth to chew on (AAP, NHS Black Country).
• Chilled soft fruit, from 6 months. If your baby has started solids, the NHS says soft fruit like melon can soothe gums, and an NHS team suggests chilled banana and melon. Serve it in a safe shape for their age: see banana, cantaloupe and watermelon. Always stay with your baby while they eat. US advice on raw fruit is different: see below.
• Cold water in a cup, from 6 months (AAP). A soft spout gives them something to chew on too. See cup and straw drinking.
• Rub their gums gently with a clean finger, or let them gnaw on your finger (AAP, NHS).

The NHS also mentions raw vegetables to chew on. Hard raw vegetables like carrot sticks are a choking hazard for babies (CDC), so cook them soft, or stick with soft chilled fruit.

Teething biscuits and rusks

• Choking. The AAP says chunks of teething biscuit can break off easily and lead to choking. If you offer one, keep your baby sitting upright and watch them the whole time, and take away any piece that breaks off, whatever its size, and the last small stub. Know the difference between gagging and choking.
• Sugar and salt. The AAP says most teething biscuits contain sugar and salt and aren’t very nutritious. The NHS says it’s best to avoid rusks, because nearly all brands contain some sugar.

Babies under 12 months shouldn’t have added salt, and US and UK advice is to avoid added sugar up to age 4, so ordinary family food in a safe texture is a better choice. See salt and sugar for babies.

Gels and products to avoid

• Benzocaine and lidocaine gels. The FDA warns that teething creams, gels and tablets containing benzocaine or lidocaine offer little or no benefit and can be dangerous for children. Benzocaine can cause methemoglobinemia, a serious and sometimes fatal condition that reduces how much oxygen the blood can carry. Lidocaine can cause seizures, heart problems, severe brain injury and death (FDA, AAP). Numbing gels can also numb the throat and make swallowing harder (AAP).
• Homeopathic teething tablets and gels, especially those with belladonna (AAP, FDA).
• Amber teething necklaces, and bracelets or necklaces made of wood, marble or silicone. The FDA has received reports of deaths and serious injuries, including strangulation and choking, caused by teething jewelry. Never tie a teething ring around your baby’s neck either (NHS).
• Alcohol rubbed on the gums, which can cause seizures (AAP).

If your baby is very uncomfortable, ask your pediatrician, GP or pharmacist about pain relief such as acetaminophen (paracetamol). Use a sugar-free medicine and follow the dose for your baby’s age and weight (AAP, NHS). Age limits differ between the US and UK: see below. Never give aspirin to a child under 16 (NHS).

When it isn’t teething

The AAP says studies show teething does not cause fever, diarrhea or a lot of extra crying, and the NHS says there’s no evidence it causes diarrhea. A true fever, 38°C (100.4°F) or higher, is a sign of illness or infection (AAP).

Call your pediatrician, GP or NHS 111 if your baby:

• has a temperature of 38°C (100.4°F) or higher: if they’re under 3 months, call right away (AAP). In the UK, the NHS says 38°C or more under 3 months, or 39°C or more at 3 to 6 months, needs 999 (see below)
• has diarrhea that lasts more than a day (AAP)
• is crying much more than usual (AAP)
• isn’t feeding, or hasn’t had a drink in 8 hours while awake (NHS)
• has any symptom that worries you (NHS)

Call 911 or go to the emergency room if your baby:Call 999 or go to A&E if your baby:Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department if your baby:

• is floppy, very hard to wake, or can’t be woken
• is struggling to breathe, breathing very fast, or grunting
• has blue, gray, pale or blotchy skin, lips or tongue (on brown or black skin, check the palms and soles)
• has a rash that doesn’t fade when you press it
• has a weak, high-pitched or nonstop cry
• has a seizure
• is under 3 months old with a temperature of 38°C or higher, or 3 to 6 months old with 39°C or higheris under 3 months old with a temperature of 100.4°F (38°C) or higher and you can’t reach your doctor right away

These signs come from the NHS and AAP. Trust your instincts.

Where US and UK advice differs

• Teething gels. The FDA says benzocaine and lidocaine products shouldn’t be used for teething pain in children. The NHS says there’s little evidence that teething gels work and suggests trying teething rings or sugar-free pain relief first. If UK parents do use a gel, the NHS says to choose one made for young children from a pharmacy, and not general oral pain gels.
• Frozen or chilled. The NHS and FDA say not to freeze teething rings. The AAP suggests a frozen damp washcloth, but says not to let babies chew directly on anything frozen solid. A fridge-cold teether or washcloth suits both.
• Chilled raw fruit. The NHS says soft fruit like melon can soothe gums from 6 months. For babies under 1, the AAP says that apart from mashed banana, most fruits should be cooked until soft. If you follow US advice, offer mashed banana or chilled cooked fruit, or use a cooled teething ring or cold washcloth instead. Either way, check that chilled fruit still squashes easily between your finger and thumb.
• Pain relief ages. The NHS says paracetamol can be given for teething from 2 months and ibuprofen from 3 months. The AAP says to ask your pediatrician about acetaminophen (paracetamol), and ibuprofen only over 6 months. Check the label and ask a pharmacist or doctor.

Once teeth appear, brush them twice a day with a smear of fluoride toothpaste (AAP, NHS).