If your baby is drooling more than usual, gnawing on everything in reach, or fussier than you’ve come to expect, you may be wondering if those first teeth are on their way. Teething is a normal part of development, and while it can be uncomfortable for your little one, there are gentle ways to help them feel better.

The Short Answer

Most babies start teething between 4 and 7 months of age, though some may begin as early as 3 months or not until after their first birthday. Every child follows their own timeline, and both early and late teething are usually completely normal. The lower front teeth (central incisors) typically appear first, followed by the upper front teeth.

What You’ll Notice

Teething can look different from one baby to the next, but common signs include:

• Increased drooling
• Chewing or gnawing on fingers, toys, or other objects
• Swollen or tender gums, sometimes with a visible white spot where the tooth is emerging
• Fussiness or irritability, especially in the evening
• Trouble sleeping or more frequent waking at night
• Mild cheek redness on the side where a tooth is coming in
• Pulling at their ears (though this can also be a sign of an ear infection)

It’s worth noting that teething does not cause high fever, diarrhea, or significant illness. If your baby has a fever above 100.4°F (especially if they are under 3 months old), persistent diarrhea, or seems very unwell, contact your pediatrician to rule out other causes.

What’s Normal for Their Age

Teething typically follows a predictable pattern, though the exact timing varies widely. For most infants, the lower central incisors (bottom front teeth) appear first, usually between 6 and 10 months. The upper central incisors follow, often by 8 to 12 months. By around age 3, most children have all 20 of their primary (baby) teeth.

Some babies are born with a tooth already visible (a natal tooth), while others don’t cut their first tooth until after their first birthday. Both scenarios can be perfectly normal. If your baby hasn’t shown any signs of teething by 15 to 18 months, it’s a good idea to mention it at a well-child visit so your pediatrician can take a look.

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What You Can Do at Home

There are several safe, gentle strategies you can try to comfort your teething baby:

• Offer something cool to chew on. A clean, chilled (not frozen) teething ring or a damp, cold washcloth can provide soothing pressure on sore gums. Avoid teething rings that need to be frozen solid, as these can be too hard and may injure delicate gums.
• Gently rub their gums. With a clean finger, you can apply light pressure to the swollen areas. Many babies find this comforting.
• Keep them comfortable. Extra cuddles, distraction with play, and sticking to their usual sleep and feeding routines can all help.
• Wipe away drool. Frequent drooling can irritate the skin around your baby’s mouth and chin. Gently patting the area dry and applying a thin layer of petroleum jelly or a gentle barrier cream can prevent chapping.

Avoid teething tablets, gels containing benzocaine, or homeopathic teething remedies, as these have not been shown to be safe or effective and have been associated with serious risks. Your pediatrician can discuss safe options during your visit.

Is Teething Really Causing My Baby’s Symptoms?

Teething is often blamed for a wide range of symptoms, but research suggests that while it can cause mild discomfort, drooling, and gum tenderness, it does not cause high fevers, vomiting, diarrhea, or serious illness. If your baby seems truly unwell or you’re concerned about their symptoms, it’s important to have them evaluated. At Holly Springs Pediatrics, our providers can help determine whether teething, an infection, or another issue is the cause, and guide you on the best next steps.

When to Call the Pediatrician, and When It’s an Emergency

Teething itself is not an emergency, but it’s important to know when your baby’s symptoms require a call or visit:

Monitor at home if:

• Your baby is drooling, chewing, and mildly fussy but otherwise acting like themselves
• Gums are swollen or red, but there’s no fever or other worrying signs
• Symptoms are manageable with the comfort measures above

Schedule a visit (non-urgent) if:

• Your baby is over 18 months old and has not yet shown any signs of teething
• You’re unsure whether symptoms are from teething or something else
• Your baby is extremely fussy or not sleeping, and home comfort measures aren’t helping
• You have questions about teething or would like guidance during a routine checkup

Same-day or urgent care if:

• Your baby has a fever of 100.4°F or higher (rectal) and is younger than 3 months old
• Your older infant or toddler has a persistent fever along with other symptoms like pulling at ears, rash, vomiting, or diarrhea
• Your baby is refusing to eat or drink and you’re concerned about dehydration (fewer wet diapers, dry mouth, sunken soft spot, no tears when crying)
• There’s significant bleeding from the gums or mouth

Go to the ER or call 911 if:

• Your baby is having difficulty breathing
• They are extremely lethargic, unresponsive, or you cannot wake them
• There is a seizure or loss of consciousness
• You see a rash that does not fade when you press on it, especially if your baby also has a fever

How It’s Evaluated

If you bring your baby in for a visit, your pediatrician will ask about the symptoms you’ve noticed, when they started, and how your baby has been eating, sleeping, and behaving overall. They will examine your baby’s mouth and gums, check for emerging teeth, and look for other possible causes of discomfort such as an ear infection, throat irritation, or illness. In most cases, no testing is needed. The evaluation is straightforward and helps ensure you have a clear understanding of what’s happening and how to help your little one feel better.

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Treatment & Management

For most babies, teething discomfort can be managed with the simple home measures described above: cool teething rings, gentle gum massage, and lots of comfort. If your baby seems particularly uncomfortable, your pediatrician may discuss age-appropriate options during your visit. It’s important not to give any over-the-counter pain relievers, teething gels, or other treatments without talking to your provider first, as safety and dosing depend on your baby’s age and weight.

Our team at Holly Springs Pediatrics can answer your questions about teething and help you find safe, effective ways to soothe your baby during this stage.

From a Pediatrics Perspective

Many caregivers worry that teething is causing serious illness or that they should be doing more to relieve their baby’s discomfort. In reality, teething is a normal developmental milestone, not a medical condition. While it can make your baby cranky and drooly for a few days, it does not make them sick. If your baby has a fever, rash, or other concerning symptoms, those deserve evaluation on their own, separate from teething.

It’s also common to feel uncertain about which teething products are safe. The marketplace is full of options, but not all of them have been tested or approved for safety. Your pediatrician is your best resource for sorting through the choices and finding what works for your family.

Questions to Ask at the Visit

When you come in for a sick visit or well-child checkup, you might want to ask:

• Is what I’m seeing consistent with teething, or could something else be going on?
• Are there any safe options to help with discomfort that I haven’t tried yet?
• When should I expect the next teeth to come in?
• How can I tell the difference between teething fussiness and an ear infection or other illness?
• Is it normal for my baby to refuse certain foods or bottles during teething?
• When should I start brushing my baby’s teeth, and what should I use?

You’re Not Alone in This

Teething is one of those phases that can feel long when you’re in the middle of it, especially during sleepless nights and fussy afternoons. But it’s temporary, and there are safe, gentle ways to help your baby through it. If you’re ever unsure whether what you’re seeing is typical teething or something that needs attention, trust your instincts and reach out.

Holly Springs Pediatrics is here for families from Holly Springs, Apex, Cary, Fuquay-Varina, New Hill, Morrisville, and throughout the surrounding areas. Whether you have questions about teething, need guidance on soothing your baby, or want to schedule a well-child visit to talk through developmental milestones, our team is ready to support you. You can request an appointment anytime, and we’ll help you and your little one navigate this stage with confidence and care.