Most babies get their first tooth between 4 and 7 months, usually a bottom or top front tooth. Expect drooling, chewing and fussiness. Cold, firm teething rings and gum massage help. Teething does not cause a real fever, diarrhea or vomiting.
If your baby is drooling through three outfits a day and gnawing on your shoulder, teeth are a reasonable explanation. The next few paragraphs cover what to expect and — more usefully — what to stop blaming on teething.
When does teething start?
The AAP says babies typically start teething at about 4 to 7 months old, with the two front teeth (central incisors), upper or lower, usually appearing first.
Some babies are born with a tooth. Some have a gummy grin at 13 months. Both ends of that range are normal, and neither predicts anything about your child. If there is no tooth at all by around 18 months, mention it at a well visit.
What are the real symptoms of teething?
The AAP's symptom guidance is narrower than the internet's. The symptoms it identifies as genuinely linked to teething:
- Increased drooling
- An increased need to chew on things
- Fussiness and irritability
- Swollen, tender gums
- A slight rise in temperature — but not over 101°F (38.3°C)
That number matters. The AAP puts the ceiling at 101°F (38.3°C) and says to call your pediatrician for anything above it. Anything higher is not teething, and treating it as teething is how a real illness gets missed for a day.
Does teething cause fever, diarrhea or rashes?
No. The AAP is blunt about this: teething does not cause fever, diarrhea, diaper rash or runny nose, and it does not cause a lot of crying.
Call your pediatrician if your baby has:
- A temperature over 101°F (38.3°C) — and if your baby is under 3 months old, a rectal temperature of 100.4°F (38°C) or higher means the emergency room, immediately, no exceptions
- Diarrhea or vomiting
- A body rash
- Inconsolable crying
- Refusal to feed
Teething gets blamed for a great deal it does not cause. Ruling it out costs a phone call.
What about pulling on ears — is that teething?
Ear pulling is on nearly every teething list online, and it should not be. The AAP's position: most ear pulling or touching between 4 and 12 months is normal behavior — babies discovering they have ears — and ear pulling without other symptoms is not a sign of an ear infection.
What changes the picture is what comes with it. The AAP says to call your pediatrician within 24 hours if ear pulling comes alongside fever, crying, apparent pain, cold symptoms, or drainage from the ear, and during office hours if the pulling lasts more than three days. Ear pulling on its own is not a symptom worth tracking. Ear pulling plus a fever is worth a call.
What actually helps a teething baby?
- Cold, firm teething rings. Chilled in the fridge, not frozen. The FDA specifically recommends a firm rubber teether that is not liquid-filled, and says not to freeze it.
- A clean, cold washcloth. Wet it, wring it out, chill it for 15 minutes, let them chew.
- Gum massage. Clean finger, gentle pressure, about two minutes, as often as needed. The AAP lists this first, and it works better than it sounds.
- Extra patience at bedtime. Sleep gets choppy for a few nights around a tooth. It settles.
The AAP's own line on medication is worth knowing: "Pain medicines usually are not needed for the mild discomfort of teething."
If your baby seems genuinely miserable and cold and pressure are not touching it, ask your pediatrician about an appropriate option and the right dose for your baby's weight. Infant dosing is calculated by weight, not age, and the two do not track reliably. Do not dose from a chart you found online, and do not carry over a dose a friend used for their baby.
What should I avoid?
The FDA has issued specific warnings on all of these:
- Benzocaine gels and liquids. These can cause methemoglobinemia, a serious and sometimes fatal condition in which the blood's oxygen-carrying capacity drops sharply. The FDA has acted against over-the-counter benzocaine teething products.
- Lidocaine for teething. The FDA warns it can cause seizures, heart problems, severe brain injury and death in infants and young children.
- Homeopathic teething tablets, including those containing belladonna.
- Amber teething necklaces and other teething jewelry. The FDA has received reports of deaths and serious injuries, including strangulation and choking.
- Frozen teething rings. Too hard on inflamed gums.
What order do teeth come in?
Typical, not required:
- Bottom front two — 6–10 months
- Top front two — 8–12 months
- Top lateral incisors — 9–13 months
- Bottom lateral incisors — 10–16 months
- First molars — 13–19 months
- Canines — 16–23 months
- Second molars — 23–33 months
By age 3, most children have all 20 baby teeth.
Evidence note: You will read everywhere that the first molars are the worst. That is parent report, not a finding from published research — no medical body ranks teeth by pain. Plenty of families sail through molars and struggle with canines. Treat the ranking as folklore, and treat your own baby as the data.
The bottom line
Teething is uncomfortable and temporary, and it comes in waves with breaks in between. Cold, pressure and patience cover most of it. A temperature over 101°F, diarrhea, vomiting or a rash is something else, and that is a phone call to your pediatrician — not a longer night of teething rings.
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Sources
- AAP / HealthyChildren.org — When Does Teething Start?
- AAP / HealthyChildren.org — Teething (symptom guide)
- AAP / HealthyChildren.org — Ear — Pulling At or Rubbing
- U.S. Food & Drug Administration — Safely Soothing Teething Pain in Infants and Children
- AAP / HealthyChildren.org — Fever and Your Baby
Last medically reviewed: August 2026 Last updated: August 2026
For informational purposes only — not medical advice. This article does not replace guidance from your pediatrician, who knows your baby. Always consult your healthcare provider for medical questions about your child.
In an emergency, call 911. For a suspected poisoning or a swallowed substance, call Poison Control at 1-800-222-1222 (free, 24/7).