Teething Symptoms in Babies: What’s Normal, What’s Not, and When to Reach for Medicine

If your baby has suddenly turned into a drooly, cranky little piranha who chews on everything from their fists to your car keys, welcome to the teething club. It’s a season every parent goes through, and while it’s perfectly normal, it can be confusing to know what’s really caused by teething and what needs a doctor’s check.

As a mom of two toddlers, I’ve been (and still am) in the trenches of teething. The sleepless nights and the constant guessing game of “Is this teething or something else?” That, combined with my nursing background, is exactly why I put this guide together, so that you (and I) have something to look to for comfort.

Some parents swear that teething explains every rash, runny tummy, or sleepless night. Others worry about when to give medicine like Calpol or Nurofen, or whether old-fashioned remedies like teething powders and oils actually help.

In this guide, we’ll break it down from what’s happening under those gums to the real teething symptoms in babies (and the myths), and safe ways to help. Because teething may be tough, but it doesn’t have to be difficult to understand.

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What’s Really Happening Under the Gums During Teething

Babies aren’t born toothless. In fact, all 20 of their milk teeth are already in their gums (not fully formed yet, but there) before birth. They start developing in pregnancy, around the second trimester, and develop further after birth until it’s their time to erupt.

That “eruption” is when the tooth slowly pushes through the gum tissue. It usually begins somewhere between 4 (more like 6 in most cases) and 12 months, with the bottom front teeth (lower central incisors) often making the first appearance. Some babies show a tooth as early as 4 months, others keep their gummy grin until close to a year, and both are completely normal.

As the tooth moves upward, it presses on the gums, causing swelling, drooling, and fussiness. This is why teething often gets blamed for so many baby mood swings. It’s not the tooth itself that hurts, but the gum tissue being stretched and irritated as the tooth makes its way through.

👉 Key takeaway: There’s no single “right” age for teething. Timing depends on your baby’s genetics, growth, and sometimes even family history (if you or your partner were early or late teethers, your little one might follow suit).

All 20 baby teeth sit hidden in the jawbone, waiting for their turn to erupt.

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What Actually Happens During Teething

Teething isn’t just a tooth magically popping out of the gum overnight. It’s a slow, layered process happening beneath the gum surface:

1. Formation in the jaw

   
   

All 20 milk teeth are already present before birth, sitting inside the jawbone under the gums.

2. Movement through bone

   
   

As your baby grows, the roots of these teeth push them upward. They don’t just head straight for the gum. They actually travel through the jawbone itself first. This pressure on the bone and tissue underneath is part of why teething can feel so uncomfortable.

3. Eruption through the gums

   
   

Once the tooth reaches the top of the jawbone, it presses against the gum tissue. The gum stretches and thins until the tooth finally breaks through, that little white ridge you first notice. This is when drooling, gnawing, and general fussiness often peak.

4. Settling in place

   
   

After the tooth emerges, it keeps moving a bit more until it’s fully visible. This stage is usually less uncomfortable, but the gums can still feel tender.

So when you wonder why your baby is so irritable, it’s not the sharp edge of the tooth “cutting” the gum, it’s the deep pressure of a tooth traveling through bone and tissue that causes the crankiness, too.

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What’s The Normal Age for Teething?

Most babies get their first tooth between 4 and 12 months. The lower front teeth (bottom central incisors) usually arrive first, followed by the top front teeth.

🦷 Earlier is fine: Some babies start teething as early as 3–4 months.

🦷 Later is also fine: Others don’t sprout their first tooth until after their first birthday.

Both are normal and usually linked to genetics (if you or your partner were late teethers, your baby may follow the same pattern).

What If My Baby's Teething Is Late?

A “late teether” isn’t automatically a cause for concern. Many healthy babies don’t get teeth until 12–15 months. Late eruption doesn’t affect how strong the teeth will be, and it doesn’t mean your child will struggle with eating or talking.

When to check up on late teething:

• No teeth at all by 18 months

• Signs of poor growth, delayed milestones, or other health concerns

• Unusual changes in the gums (swelling without teeth, lumps that don’t resolve)

  
  

In rare cases, late teething can be linked to nutritional issues (like vitamin D deficiency) or underlying health conditions, but most of the time, it’s just part of your child’s natural growth pattern.

💡 Fun fact: Once those first teeth appear, they usually keep coming in pairs every few weeks until your child has a full set of 20 by age 2–3.

What Happens If Teeth Don’t Come In?

If your baby hasn’t sprouted a single tooth by 18 months, your nurse or doctor may suggest a quick check-up. Most of the time, it’s nothing serious — some children are simply late bloomers.

What a healthcare provider may do:

• Take a history: Checking family patterns (were you or your partner late teethers?), feeding, growth, and development.

  
  

• Examine the gums: Sometimes, teeth are there but just under the surface.

  
  

• Check overall growth: Delayed teething, combined with other delays (such as poor weight gain or late milestones), may indicate a more serious issue.

  
  

• Order an X-ray (rare): only if there’s concern that teeth are missing entirely, which is uncommon.

  
  

Possible causes of significantly delayed teething include genetics, nutritional deficiencies (like vitamin D), or, in rare cases, developmental conditions. Fortunately, most babies just catch up on their own. When teeth do come, they’re just as healthy and functional as those that arrived earlier.

The typical teething timeline: most babies sprout teeth between 6 and 12 months.

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Common Teething Symptoms in Babies (Rash, Nappies, Vomiting & More)

Here’s what is actually linked to teething, and what is more likely something else. I have woven in the exact things parents in Centurion Google, so you can spot what is normal and what needs a check.

Drooling, chewing, fussiness

Extra saliva soothes irritated gums, so babies drool and want to chew anything they can grip. You may see bumpy or red gums where the tooth is moving. Wipe gently, use a soft bib, and consider a thin layer of barrier ointment on the chin to prevent a teething rash on the chest or tummy from constant dribble.

Sleep disruption

Pain signals are louder at night when your baby is not distracted, and saliva pools when lying flat, so nights can be rough. Offer comfort, a chilled teether before bedtime, and pain medicine only if they are clearly miserable and other tricks have failed. Try to keep the same bedtime rhythm so sleep does not unravel.

Ear pulling and cheek rubbing

Teeth and ears share nerve pathways. Babies often rub their cheeks or tug their ears on the side where a tooth is erupting. If there is a fever, a very irritable baby, or fluid from the ear that is not due to teething, please book a check-up for an ear infection.

“Teething nappies” and rashes

Parents often ask what teething nappies look like. Teething itself does not cause true diarrhoea. Swallowing lots of saliva can make stools slightly looser or more frequent for a day or two, and this acidity can trigger a teething rash on the bum.

What helps:

• Thick zinc barrier cream every nappy change.

• Frequent nappy changes, cotton nappies, or breathable disposables.

• Warm water to clean, avoid fragranced wipes while the skin is sore.

  
  

Not teething: watery stools that soak the nappy repeatedly, blood or mucus in stool, a rash with blisters or pus, or a rash that does not improve after two days of good barrier care.

Vomiting and teething

You will see many searches like teething vomiting, does teething cause vomiting, will teething cause vomiting. Teething can cause gagging from excess drool and occasional small spit-ups. Repeated or forceful vomiting is not from teething and usually means an infection, food reaction, or another cause that needs assessment.

Quick “is it teething or not?” guide

• Mild temperature or warm gums can happen, but a fever of 38°C or higher is not teething.

• Slightly looser stools can occur, but true diarrhoea or dehydration is not a sign of teething.

• Extra drooling and chewing are common. Persistent vomiting is not teething.

• Local skin irritation from drool is common. Widespread rash or rash with blisters is not teething.

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Call us if your baby is under 3 months and seems unwell, has a fever of 38°C or higher, has diarrhoea or vomiting beyond 24 hours, is very sleepy, or has fewer wet nappies.

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Mild symptoms are normal in teething, but fever, vomiting, or rash need medical review.

Comfort Tricks That Really Work for Teething

Sometimes medicine isn’t needed, just simple ways to soothe sore gums. Here’s what actually helps, and how to do it safely.

Chilled teething toys & cloths

Cold numbs gum discomfort and reduces inflammation, but never freeze teethers (rock-hard surfaces can damage tiny gums or teeth). Instead, pop a silicone teether or a clean, damp washcloth into the fridge for 20–30 minutes.

👉 Sterilising teething toys:

Teethers should be washed daily in warm, soapy water. Silicone or rubber teething toys can usually be sterilised by boiling for 5 minutes (check the packaging first). Wooden teethers should not be boiled. Just wipe them with a damp cloth and mild baby-safe soap.

Breast milk lollies/ice cubes for teething

This hack is both soothing and nourishing. Express a small amount of breast milk and freeze it in:

• Mesh feeders or silicone feeders (safe for gums, reduces choking risk)

• Mini ice-cube trays (then pop a cube into a feeder)

  
  

The cool milk eases gum pain, while sucking helps comfort your baby. Formula can be used the same way if your baby isn’t breastfed. Never give plain ice cubes, which are a choking hazard and might be too much water for a small baby.

Distraction & extra cuddles

Sometimes, nothing works better than you. Rocking, singing, or offering extra feeds can calm your baby’s nervous system, which in turn helps them cope with the gum discomfort. Skin-to-skin contact and baby-wearing are underrated but powerful comfort tools.

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🚨 Important note: Avoid old-fashioned remedies like dipping dummies in honey or alcohol, or giving rusks to very young babies, as they’re unsafe. Stick to cold comfort, safe chewing, and closeness.

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Medicines for Teething Pain

Quick note on dosing: always dose by current weight, not age alone. Use our Medicine Dosing Guide and speak to your nurse or doctor if unsure.

Paracetamol (Panado®, Calpol®, Empaped®)

Paracetamol is the first-line medicine most parents reach for, and for good reason. It’s safe for young babies, effective at easing pain and fever, and comes in different forms (syrups, drops, suppositories). But it’s important to use the correct dose for your baby’s weight and not to double up across brands.

What it does	Eases pain and mild fever.
When to use it	If your baby is clearly uncomfortable and non-medication comforts haven’t helped.
Age	It can be used in young infants, but under 3 months should be clinically assessed first unless your clinician has advised otherwise.
How often:	Weight-based dosing, usually every 4–6 hours, max four doses in 24 hours.
Forms:	Syrup, drops, or Empaped® suppositories if they won’t keep syrup down. Suppositories are still paracetamol — follow the same total daily limit.
Avoid/Be careful:	Do not double up across brands (Panado + Calpol = still paracetamol). Watch other combination products that may already contain paracetamol.

Ibuprofen (Nurofen®, Brufen® syrup)

Ibuprofen can be especially useful for teething because, unlike paracetamol, it also reduces gum inflammation. It usually works a little longer, too (6–8 hours of relief instead of 4–6). But it should only be used from 6 months of age, and not if your baby is dehydrated or unwell with tummy issues.

What it does	Pain relief and reduces gum inflammation, which is why some babies do better on it for teething.
Age	Generally, from 6 months and above (or ≥7 kg), unless a clinician advises otherwise.
How often:	Weight-based dosing, usually every 6–8 hours, max 3–4 doses in 24 hours.
Give with:	A little milk/food to protect the tummy.
Avoid/Be careful:	If your child is dehydrated (vomiting/diarrhoea), has kidney problems, reflux that worsens with ibuprofen, or has a known NSAID allergy.

👉 Not sure whether to use paracetamol or ibuprofen? Start with paracetamol. If still miserable, ibuprofen can be used instead at the next dose time. Alternating can be done with clinician guidance, but don’t overlap dosing times or exceed daily limits. Use this Medicine Dosing Guide.

“Teething mixtures” and syrups

Many parents still ask about teething mixtures, but most of the old-fashioned syrups have been phased out because they contained alcohol, sedatives, or multiple ingredients that weren’t safe for babies. If you’re offered a “teething syrup,” check the label carefully. Safe options should only contain paracetamol or ibuprofen as the active ingredient.

Teething powders/tablets (incl. Homeopathic)

Numbing gels and teething oils are often marketed as quick fixes, but they come with risks. Gels with benzocaine or salicylates are unsafe for babies, and essential oils (like clove) can irritate or be toxic. If you use a gel, stick to a pharmacy-approved infant product, apply a tiny amount with a clean finger, and never right before feeding.

Teething gels and “teething oil”

Numbing gels and teething oils are often marketed as quick fixes, but they come with risks. Gels with benzocaine or salicylates are unsafe for babies, and essential oils (like clove) can irritate or be toxic. If you use a gel, stick to a pharmacy-approved infant product, apply a very small amount with a clean finger, and never right before feeding.

When not to give medicine (even if you think it’s teething)

• A fever of 38°C or higher, ongoing vomiting, true diarrhoea, or a widespread rash are not signs of teething. Please book a medical check.

  
  

• If your baby is under 3 months old and seems unwell, always seek a clinical assessment first. Teething at this age is very rare.

  
  

• If you’ve already given the maximum daily doses of paracetamol or ibuprofen and your baby is still miserable, it’s time to see a healthcare professional.

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Teething is temporary, and every tooth brings your baby closer to that full, cheeky grin.

FAQs Parents Have About Teething

What’s the best medicine for teething babies or toddlers?

The safest and most effective options are paracetamol and ibuprofen. Paracetamol (Panado, Calpol) is a good first choice for pain. Ibuprofen (Nurofen, Brufen) can be used from 6 months and often helps more with gum inflammation. Always dose according to your baby’s current weight.

Can teething cause vomiting or diarrhoea?

Teething can cause extra drool, which may lead to mild gagging or slightly looser stools for a short time. But true diarrhoea, repeated vomiting, watery nappies, or signs of dehydration are not caused by teething and usually point to an infection or another illness.

Do babies get a fever when teething?

Teething may cause warm cheeks or slightly tender gums, but it does not cause a fever. A temperature of 38°C or higher is almost always due to an illness, not teething.

What does a teething rash look like?

A teething rash is usually a red, irritated patch around the mouth, chin, neck, or chest from constant drool. It should improve with barrier cream and gentle wiping. A rash with blisters, spreading redness, or pus isn’t from teething.

What are the earliest signs of teething?

Early signs include drooling, chewing on hands or toys, swollen or bumpy gums, rubbing their cheeks or ears, and fussier nights. Some babies show symptoms weeks before the tooth appears, while others get their first tooth with almost no warning.

How long can I give Calpol (Paracetamol) for teething?

Paracetamol can be given safely for a few days during a difficult teething patch, as long as your baby gets no more than four doses in 24 hours and is dosed by weight. Avoid combining multiple paracetamol products. If your baby still needs daily medicine after three days, get them checked.

How can I soothe teething pain at night?

Use a chilled teether before bed, keep a predictable bedtime routine, and give weight-based paracetamol if your baby is clearly uncomfortable. Night-time teething feels worse because there are fewer distractions and saliva pools when lying flat.

When should I worry that it’s not teething?

It’s unlikely to be teething if your baby has a fever of 38°C or higher, vomiting, true diarrhoea, a spreading rash, fewer wet nappies, or signs of dehydration. Babies under 3 months with “teething-like” symptoms should always be checked, as teething rarely starts this early.

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Teething is uncomfortable, but it shouldn’t make your baby sick. If you’re reaching for medicine often or are unsure whether it’s teething at all, check in with your nurse or doctor.

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When It’s Not Teething (Red Flags to Watch For)

Teething can explain drool, chewing, and cranky nights, but it should not cause serious illness. If you see any of these, it’s time to get checked rather than blaming teething:

• Persistent fever (≥ 38°C), especially if it lasts more than a day

• Repeated vomiting or true diarrhoea (watery nappies soaking through, blood or mucus in stool)

• Refusal to feed or drink, fewer wet nappies, or signs of dehydration

• Rashes that don’t improve with good barrier cream, or rashes with blisters/pus

• Baby under 3 months. Teething rarely starts this early, so fussiness plus “teething-like” symptoms should always be assessed by a doctor

The golden rule: if your gut says, “This feels like more than teething,” trust it and book a check.

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Teething Doesn’t Last Forever (Here’s Your Takeaway)

Teething can feel endless when you’re in the thick of it, the drool, the midnight wake-ups, the chewed-up TV remotes. But it’s temporary, not dangerous, and your baby (and you) will get through it just fine.

There are safe ways to help, from chilled teethers and breast milk lollies to properly dosed medicines like Calpol or Nurofen when comfort alone isn’t enough. And while teething explains a lot of fussiness, it should never be blamed for serious illness.

Before you know it, those gummy grins will be replaced by a full set of pearly whites, and the photos will make the sleepless nights worth it.

💬 Unsure if it’s really teething? 

Book a consultation with us at Mums & Bums Clinic in Centurion. We’ll guide you through teething, check red flags, and help you feel confident about what your baby needs.

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