Teething Tips

When should we expect our baby's teeth to appear?

When teeth first appear is as unexpected as the timing of baby's first steps, but in general, expect the first sharp nubbin around six months; some babies teethe earlier, some later. Heredity plays a part. If you check your own baby book, if grandmother was a tooth-record keeper, your baby's teething schedule may resemble yours.

Actually, babies are born with a full set of twenty primary teeth. They are just buried in the gums, waiting in line for their time to sprout. Teeth push through in upper and lower pairs, usually the lower appear before their upper gum mates, and girls teethe slightly earlier than boys. The "rule of fours" is how teeth usually appear. Beginning around six months expect four new teeth every four months until complete, usually by two-and-a-half years. Teeth come through gums at unusual angles. Some come out straight, other first appear crooked but straighten as they twist their way through. Don't fret about spaces. It's easier to clean between spaced teeth, and the spacing of baby teeth does not necessarily reflect how the permanent teeth will appear.

How much should we expect teething to bother our baby?

As you wonder why your sleeping angel turns nightwaker, you hear the telltale ping against the spoon or feel the cutting edge. Actually babies don't "cut teeth," nor do teeth "erupt." Teeth slowly slide and twist their way through gum tissue. But sharp teeth pushing through sensitive gums do hurt, and babies protest. Here are the nuisances to expect and suggestions to comfort the budding teether.

Drooling. During teething time, expect the saliva faucet to be on. In addition, listen for the young announcer's voice to sputter. Many of the following aggravations stem from this excessive drool.

Drool rash. Sensitive skin and excessive saliva don't sit well together, especially when the skin is rubbing against a drool-soaked bed sheet. Expect a red, raised, irritating rash around baby's lips and chin. Place a drool-absorbing cotton nappy under baby's chin or a towel under the sheet while baby sleeps. Gently wipe excess drool off the skin with lukewarm water and pat (don't rub) dry. Lubricate with a mild emollient.

Drool diarrhea. Not only does the face react to excess saliva, so does the bottom. Expect loose stools and a mild nappy rash during peak teething time. This temporary nuisance self-clears as each teething burst subsides. Apply a barrier ointment to baby's bottom.

Fever and irritability. The inflammation caused by hard teeth pushing through soft tissue may produce a low fever  38.3 degrees C and the disposition of someone who hurts. Give baby Panado as needed. (See for the appropriate dosage.)

Biting. The budding teether longs for something or someone to gnaw on. Teeth marks on crib rails and clicking gums on silver spoons are telltale signs of sore gums. Babies may also nibble on your knuckles, arms, fingers, and sometimes the breast that feeds them. Offer something cool and hard. Gum-soothing favorites are a cool spoon, popsicle, frozen bagel, and a teething ring,. Try cold teething biscuits for another melt-in-the-mouth teether.

Nightwaking. Growing teeth don't rest at night; neither do teething babies and their parents. A previously steady sleeper may frequently awaken during peak teething times and may have difficulty resettling into the preteething sleep schedule. Offer a dose of Panado before bedtime or, if baby is in severe pain, a one-time double dose. Repeat the dose four hours later if needed.

Refusing to feed. This is the most variable of all teething concerns. Some teethers never miss a meal, others accelerate their nursing for comfort, and a few may pass up even their most trusted human pacifier. Offer cool, mushy foods—for example, applesauce and frozen fruit juice slush. Put these on a cool spoon to make a real hit.

How can I tell if my baby is teething?

Besides the trademark drool and crankiness, try the gum-massage test. (Babies are more likely to accept a finger probing into their mouth than to allow a look.) Run your finger along the front edges of the gums, and you will feel swollen ridges of preteething gums. It is sometimes difficult to tell if a baby is teething because the amount of teething discomfort varies considerably among babies. Some are steady, once-a-month teethers; many teethe in bursts and pauses, where suddenly baby has a miserable week and you feel four swollen ridges along the gum line. Expect the most discomfort when many teeth come through at once. Some babies experience exquisite pain and swelling during molar teething. If allowed to look, you may notice a mound of swollen tissue around a budding tooth. Don't be alarmed if you notice a mushy blue blister above an erupting tooth. This is actually a collection of blood beneath the superficial layer of gum tissue. These painful swellings are best treated by cool compresses (for example, popsicles), which soothe the swelling.

IS BABY SICK OR TEETHING? HOW TO TELL

When in doubt, don't attribute baby's behavior to teething. Let your doctor decide. Yet, here are some general ways to tell the difference between teething and an illness such as an ear infection:

1. Teething mucus is clear saliva and doesn't run out the nose. Cold mucus is thick and yellow. A nasal discharge usually means an allergy or an infection, especially if accompanied by eye drainage.

2. Teething rarely causes a fever higher than 38.3° C)

3. Teething may be confused with an earache. Babies pull at their ears during teething, probably because of pain radiating from the teeth to the ears. Some babies just like playing with their ears. Ear-pulling in babies is an unreliable sign. With an ear infection babies usually hurt more lying down and have accompanying signs of a cold.

4. Babies don't act progressively sicker with teething. As a general rule, when in doubt, have your doctor check it out.