Teething symptoms 4 months old

Baby teething symptoms - NHS

When it comes to teething, all babies are different. But your baby will probably get their first tooth some time during their first year.

Find out how to spot when your baby is teething and what order your baby's teeth are likely to appear in.

When do babies start teething?

Some babies are born with their first teeth. Others start teething before they are 4 months old, and some after 12 months. But most babies start teething at around 6 months.

Teething symptoms

Baby teeth sometimes emerge with no pain or discomfort at all.

At other times, you may notice:

their gum is sore and red where the tooth is coming through
they have a mild temperature of less than 38C
they have 1 flushed cheek
they have a rash on their face
they're rubbing their ear
they're dribbling more than usual
they're gnawing and chewing on things a lot
they're more fretful than usual
they're not sleeping very well

Read tips on how to help your teething baby.

Some people think that teething causes other symptoms, such as diarrhoea, but there's no evidence to support this.

You know your baby best. Get medical advice if they have any symptoms that are causing you concern. You can call NHS 111 or contact a GP.

Read more about spotting the signs of serious illness in babies and toddlers.

What order do baby teeth appear in?

Here's a rough guide to how babies' teeth usually emerge:

bottom incisors (bottom front teeth) – these are usually the first to come through, usually at around 5 to 7 months
top incisors (top front teeth) – these tend to come through at about 6 to 8 months
top lateral incisors (either side of the top front teeth) – these come through at around 9 to 11 months
bottom lateral incisors (either side of the bottom front teeth) – these come through at around 10 to 12 months
first molars (back teeth) – these come through at around 12 to 16 months
canines (between the lateral incisors and the first molars) – these come through at around 16 to 20 months
second molars – these come through at around 20 to 30 months

Most children will have all of their milk teeth by the time they are between 2 and 3 years old.

Community content from HealthUnlocked

Page last reviewed: 9 August 2022
Next review due: 9 August 2025

Teething in Babies: Symptoms and Remedies

Written by WebMD Editorial Contributors

What Is Teething?

Teething is when your baby’s teeth start to come through their gum line. Another word for it is odontiasis.

When Do Babies Start Teething?

Most babies begin to teethe between 4 and 7 months old, but some start much later. There’s no need to worry if your baby’s teeth come in on another timetable -- it can be different for every baby.

Signs and Symptoms of Teething

The symptoms aren’t the same for every baby, but they may include:

Swollen, tender gums
Fussiness and crying
A slightly raised temperature (less than 101 F)
Gnawing or wanting to chew on hard things
Lots of drool, which can cause a rash on their face
Coughing
Rubbing their cheek or pulling their ear
Bringing their hands to their mouth
Changes in eating or sleeping patterns

Teething can be painful, but it doesn’t usually make babies sick. Call your doctor if your baby has diarrhea, vomiting, rashes on the body, a higher fever, or cough and congestion. These aren’t normal signs of teething.

You also should call the pediatrician if your baby’s gums are bleeding or you see any pus or swelling of their face.

Order of Tooth Eruption

When and how teeth come in can be different for every baby and may be based on family history. But most of the time, the lower front two teeth come in first, followed by the opposite top two teeth and the two on either side of those. Next come the two on either side of the bottom front teeth, then the first molars appear. The teeth in front of the first molars are next, and the back molars are the last ones to come in.

In all, 20 “baby teeth” will eventually be in place, usually by age 3.

Soothe a Teething Baby

What works to soothe a friend’s baby might not work for yours. You may need to try different things to help your little one feel better:

Something cold in your baby’s mouth, like a cold pacifier, spoon, clean wet washcloth, or a solid (not liquid) refrigerated teething toy or ring. Some experts say frozen teething toys are too cold and may hurt your baby’s mouth. Make sure to clean teething toys, washcloths, and other items after the baby uses them.
Try offering a hard, unsweetened teething cracker.
If your baby is older than 6-9 months, you can offer cool water from a sippy cup, too.
Massage the gums by gently rubbing them with your clean finger. If the teeth haven’t come in yet, you can let your baby gnaw on your finger. If you’re nursing your baby, try dipping your fingers in cool water and massaging their gums before each feeding. That may keep them from biting your nipple while nursing.

Treatments to Avoid

Never put anything in your baby’s mouth that isn’t specifically approved to help soothe teething. Even some products described as teethers or teething aids aren’t safe choices, including ones:

Filled with liquid that can tear and spill
Made of breakable material, like plastic, that can possibly lead to choking
That are frozen solid -- these can be too hard on a baby’s mouth

Another reason to be aware of the material used to make the teethers: Some can be made from harmful substances, like lead. Look for ones made of rubber.

Teething Necklaces

Child health experts don’t recommend teething necklaces. They’re dangerous: They can strangle the baby. They also can choke if the necklace breaks and they swallow the beads.

If you do choose to use one, make sure to:

Put it on a wrist or ankle, not around the baby’s neck.
Always watch your baby when they wear it.
Take it away when you aren’t watching your baby, even for a very short time.

You may have heard that amber teething necklaces release a pain reliever when heated. That’s not proven, and doctors say using one is not a good idea.

Teething Medicine

Medicine that you rub on your baby’s gums to stop the pain of teething may not help. It quickly washes away in the mouth and may numb the back of their throat and make it hard for them to swallow.

Stay away from over-the-counter teething gels and liquids that have the ingredient benzocaine. The FDA says this ingredient shouldn’t be given to children under 2. It can cause rare but serious side effects.

A small dose of a children’s pain reliever, such as acetaminophen, may help your baby. Don’t use ibuprofen for an infant under 6 months old, and ask your doctor before giving your baby any medication. Use it exactly as the doctor says.

Teething can be rough for you and your baby at first. But it’ll get easier as you both learn how to soothe each new tooth that pops out.

How to Care for Baby’s New Teeth

Good oral hygiene is important, even before your baby has teeth:

Until teeth start to come in, clean your baby’s gums with a wet washcloth or piece of gauze at least once a day.
Once they have teeth, clean your baby’s mouth the same way at least twice a day. After feedings is a good time for this.
After their first birthday, you can start to use a soft-bristled baby toothbrush with water and a small amount of toothpaste that doesn’t have fluoride in it. You can also start flossing between their teeth.

The pediatrician will monitor your baby's teeth for decay and will decide if a referral to a dentist is needed prior to age 1. For most kids, the pediatrician can continue to screen teeth until age 3.

Symptoms of teething in children under one year old and ways to alleviate them

In the first year of life, the child develops rapidly. He learns to sit, crawl, walk. And he also has something that indicates the general physiological development, the maturation of the digestive system. He is preparing to move from feeding exclusively on milk or formula to a new stage - to the use of semi-solid and solid foods and the appearance of the first milk teeth .

The eruption of the first milk teeth is influenced by genetic characteristics, health, nutrition and other factors. Even the dependence of teething in infants on the region of residence has been established. So, in the northern regions of Russia, there is a frequent deviation from the average terms towards a later eruption of ^[1] .

On average, the first baby tooth appears at 6-7 months. Within three years, all 20 milk teeth will take their place in the dentition. In some babies, teething begins at 4-5 months, someone waits up to 10-12 months. All this is the range of the norm ^[2].

There are several theories explaining the process of teething ^[2] :

Hunter's theory - pushing a tooth out of the bone alveolus occurs due to the pressure of growing roots; nine0006
Yasvoin's theory - the appearance of a tooth above the gum provokes processes of differentiation in the tissue of the dental papilla;
Katz's theory - an increase in tissue pressure in the area of the bottom of the alveoli directs the tooth to the surface.

But none of them can fully explain this complex mechanism.

By the time of tooth eruption, the area of bone covering the crown of the tooth has been resorbed. The same processes are noted in the gum. During the growth of the tooth root, the bone is also rebuilt and the dental alveoli gradually deepen. At the same time, morphological changes in the tissues surrounding the tooth occur: increased blood flow, changes in vascular permeability, increased production of the main substance of the pulp and periodontium
"Can the physiological process of teething in infants be pathological?" Doctor of Medical Sciences, Professor, Chief Pediatrician of the Central Federal District of the Russian Federation, Honored Doctor of the Russian Federation Zakharova I. N. ^[2]

It is not surprising that the appearance of teeth causes discomfort in children at any age, but this process is especially difficult for babies.

Symptoms of teething in a child

The appearance of milk teeth is a natural physiological process, however, a number of children develop a symptom complex, which, according to the International Classification of Diseases, is classified as teething syndrome (ICD code - K00.7). Numerous surveys of young children say that the most common symptoms accompanying the appearance of teeth are:

increased salivation — processes in the oral cavity are activated;
irritability - the child experiences severe discomfort and cannot report it otherwise than by changing behavior;
sleep disturbance - the pain is so severe that the baby cannot sleep or wakes up frequently during the night;
itching of the gums - children try to compensate for it by trying to bite the breast or nipple, by trying to keep hands, toys, clothes in their mouths. nine0006

Such harbingers of the appearance of a tooth occur in 35-60% of children. But some babies may have non-specific symptoms ^[2] :

On average, symptoms appear 5-8 days before the appearance of a tooth. When teething several teeth at the same time, this, as a rule, increases the discomfort.

Even if the child's symptoms are very similar to those of teething, a specialist consultation is necessary. Be sure to consult a doctor if diarrhea or fever persists for a long time. nine0006

Ways to alleviate discomfort

To ease teething in a baby, it is necessary:

provide additional attention and care from parents;
if the child is breastfed, breastfeed more frequently as this has a mild sedative effect;
purchase several silicone teethers that can be cooled and offered to the baby during the day; nine0006
massage the gums with a finger wrapped in a clean gauze pad or with a special silicone nozzle;
blot drool in time with a clean tissue to avoid irritation of the skin around the mouth;
if necessary and in agreement with the doctor, use medicines.

Today, there are pharmacological and non-pharmacological methods of therapy for the eruption of temporary teeth. nine0006

Topical preparations

Pediatricians prescribe gels and ointments as symptomatic relief for severe discomfort associated with teething.

Such teething gels and ointments with proven effectiveness are divided into 3 groups ^[1] :

Anesthetic-based analgesics (lidocaine, choline, benzocaine). Sometimes lidocaine-based preparations include anti-inflammatory or antiseptic components, providing a combined effect of the gel. nine0006
Medicines based on anti-inflammatory or antiseptic agents.
Preparations based on extracts of medicinal plants. They use extracts of Roman chamomile, boswellia, aloe, marshmallow, Indian ivy, medicinal rhubarb, calendula and other components of plant origin.

Homeopathic teething products are also produced, but their effectiveness has not been scientifically proven ^[1] .

Systemic drugs

In case of severe pain syndrome, hyperthermia, non-steroidal anti-inflammatory drugs are used, which reduce body temperature and have a systemic analgesic effect. The pediatrician should select the dosage and the drug suitable for the child.

Distractions

These include: the gum massage described above and baby teethers that help your baby temporarily relieve itchy gums. nine0006

Inspection of erupted teeth

Swelling and redness of the gums gradually subside as the infant's teeth erupt and grow, but should be monitored. Normally, the teeth should be evenly located in the dentition, not have whitish or colored spots, irregularities on the enamel.

Violation of the timing, pairing and sequence of eruption of milk teeth can serve as a marker of various diseases and disorders. For example, rickets or hypothyroidism ^[2] . It is important to record the date of appearance of each tooth and its location in the mouth. It is convenient to do this with photos saved in a separate folder on your smartphone. nine0006

Erupted Tooth Care Instructions

To clean baby's teeth, use special silicone fingertips with soft bristles. Toothpaste should be labeled as suitable for young children and free of substances that are harmful if swallowed: high concentrations of fluoride, parabens, sodium lauryl sulfate.

As soon as the first tooth shows above the gum line, it needs special care . Enamel has not yet fully formed, it is very thin, so children's caries develops rapidly. Only 10% of children manage to avoid caries and adults practically fail ^[5] . Therefore, do not postpone the preventive fight against it.

To maintain the health of milk teeth, some of which will remain with the child until the age of 10-12, it is important to visit the dentist regularly once every 3-4 months. After a year, you need to visit an orthodontist to make sure that the bite develops correctly.

List of sources

1. Zaplatnikov A. L., Kasyanova A. N., Maikova I. D. Teething syndrome in infants: a new look at an old problem 2018 // https://www.rmj.ru /articles/pediatriya/Sindrom_prorezyvaniya_zubov_u_mladencev_novyy_vzglyad_na_staruyu_problemu/ (Accessed 05/28/2020). nine0006

2. Zakharova IN, Kholodova IN, Dmitrieva Yu. A., Morozova NV, Mozzhukhina MV, Kholodov DI Can the physiological process of teething in infants be pathological? 2016 // https://cyberleninka.ru/article/n/mozhet-li-fiziologicheskiy-protsess-prorezyvaniya-zubov-u-mladentsev-byt-patologicheskim (date of access: 05/28/2020).

3. Kleschenko E. I., Zhdanova I. A., Lukisha A. N., Krakovets I. V., Smychkova E. V., Kartavtseva A. V. Symptoms of teething in infants: condition or disease? 2017 // https://cyberleninka.ru/article/n/simptomy-prorezyvaniya-zubov-u-mladentsev-sostoyanie-ili-bolezn (date of access: 05/28/2020). nine0006

4. Kiselnikova L.P., Drobotko L.N. Eruption of temporary teeth in children // https://cyberleninka. ru/article/n/prorezyvanie-vremennyh-zubov-u-detey 2017 (date of access: May 28, 2020).

5. 90 percent of children and 100 percent of adults suffer from caries, Komsomolskaya Pravda, 09/04/2016 // URL: https://www.kp.ru/daily/26429.7/3300802/ (date of access: 07/21/2020).

Teething in children: symptoms and complications

Teething in children very often raises a lot of questions from parents. As a rule, during teething, babies experience discomfort, which significantly affects the nervous system of the child and makes parents pretty worried. In our article, we will look at the order, symptoms and complications of teething. nine0006

Teething in children

In what order do teeth erupt in children? As a rule, this is the following order of growth of milk teeth:

First two lower central incisors - 6-8 months
First two upper central incisors - approx. 8 months
First two upper lateral incisors - 8-12 months
First two lower lateral incisors - 10-12 months
First four posterior teeth - 14-20 months
First four canines - 18-24 months
Second four posterior teeth - 2-3 years

Teething symptoms

What are the symptoms of teething in a one year old baby? What are the symptoms of teething in children? Typically, symptoms of teething in children under one year of age include:

Excessive salivation. It can cause coughing and hoarseness, as well as a rash around the mouth and chin
Swelling, redness and tenderness of the gums
Itchy gums. Toddlers often try to relieve it by chewing on just about anything they can get their hands on
Decreased appetite or its complete absence, as well as refusal to eat
Temperature increase
Sleep disorder
Hyperexcitability
Change chair
Runny nose

It is important to understand that when teething in children, the symptoms can be different and it is not at all necessary that the child has everything from the list. Symptoms of teething in children after one year are very often similar to those present before the year. Even with the eruption of molars in children, the symptoms may be similar, but, of course, everything is purely individual. nine0006