Teething Symptoms, Fever, and Safe Remedies: What Parents Need to Know

When Does Teething Start?

Teething — the process of a baby's first teeth pushing through the gums — typically begins around 4–7 months of age, though there's wide variation. Some babies start as early as 3 months; others don't see their first tooth until after their first birthday. Both are within the range of normal.

Most children have all 20 of their primary teeth by age 3. The lower central incisors (bottom front teeth) usually come first, followed by the upper central incisors, and then the rest follow over the next couple of years. Molars — the back teeth — tend to cause the most discomfort because of their larger surface area.

What Teething Actually Causes

Research has helped separate the real symptoms of teething from the myths. A well-designed study tracking babies through the teething process found that the symptoms most reliably associated with teething are:

• Drooling — often significant and can lead to a mild rash around the mouth, chin, or chest from saliva irritation
• Gum swelling and tenderness — the area where a tooth is about to emerge may look red, swollen, or have a small blue-gray fluid-filled bump (a benign eruption cyst)
• Increased biting and chewing — babies want to put pressure on their gums
• Fussiness and irritability — particularly in the day or two before a tooth appears
• Disrupted sleep — teething discomfort can cause more frequent waking
• Decreased appetite — soreness in the mouth may make eating uncomfortable
• Mild temperature elevation — a slight rise in body temperature (up to about 100.3°F / 38°C) has been documented during the period when teeth are actively erupting

The Fever Myth: Does Teething Cause High Fever?

This is one of the most important pediatric misconceptions to address: teething does not cause a significant fever.

Studies consistently show that while teething may cause a slight elevation in temperature (below 100.4°F / 38°C), it does not cause a true fever. If your baby has a temperature of 100.4°F (38°C) or higher, teething is not the explanation — your baby likely has an infection and needs to be evaluated.

This matters because the teething period (roughly 4 months through 3 years) coincides with the time when babies and toddlers are most susceptible to viral illnesses, ear infections, and other infections. If a baby has a genuine fever during this window, attributing it to teething and waiting it out can delay care for a real illness.

Safe Teething Remedies

The good news: there are effective, safe ways to ease teething discomfort.

Chilled (Not Frozen) Teethers

A chilled — not frozen — teething ring or toy provides counter-pressure and a mild numbing effect that can significantly ease gum discomfort. Frozen teethers are too hard and can damage sensitive gum tissue.

Firm Rubber Teethers

Solid rubber teethers without liquid filling are safe and effective. Avoid liquid-filled teethers, which can break and leak.

Gentle Gum Massage

Clean your hands and gently rub the sore gum area with a clean finger for 1–2 minutes. The counter-pressure can temporarily relieve discomfort.

Cold, Soft Foods (for babies eating solids)

Chilled yogurt, applesauce, or pureed fruits can soothe inflamed gums while providing nutrition. Cold but not frozen; soft but not hard enough to be a choking hazard.

Pain Reliever When Needed

For babies over 2 months, age-appropriate doses of infant pain reliever — ask your pediatrician which product and dose is right for your baby's weight — can help on particularly uncomfortable nights. These are appropriate for occasional use; they're not needed for every tooth.

Products to Avoid for Teething

Several popular teething products are not safe and should be avoided:

• Benzocaine gels and teething gels — The FDA warns against using benzocaine products (Orajel, Anbesol, and similar products) in children under 2 because of the risk of methemoglobinemia, a rare but serious condition that reduces the oxygen-carrying capacity of blood.
• Lidocaine viscous — Not safe for young children due to risk of seizures, heart problems, and severe breathing difficulty if accidentally swallowed.
• Teething tablets with belladonna (atropine) — The FDA has warned that some homeopathic teething tablets contain inconsistent amounts of belladonna, a toxic substance. Avoid these entirely.
• Amber teething necklaces — These pose serious strangulation and choking hazards. No evidence supports their effectiveness, and the American Academy of Pediatrics advises against them.
• Mesh or silicone feeders with frozen fruit — The cold may help briefly, but these can be a choking hazard and are difficult to clean thoroughly.

When to Call the Pediatrician

Call your pediatrician if your teething baby:

• Has a fever of 100.4°F (38°C) or higher — this is not teething
• Is inconsolable despite all comfort measures
• Has not had a first tooth by 18 months (worth a check, though still possibly normal)
• Has a visible injury to the gum or mouth
• Is refusing to eat or drink to a degree that concerns you

Frequently Asked Questions

Does teething cause fever in babies?

No — teething does not cause a true fever (100.4°F / 38°C or higher). Research shows teething may cause a very slight temperature elevation (below 100.4°F), but a real fever during the teething period is caused by an illness, not the teeth. If your baby has a fever of 100.4°F or higher, contact your pediatrician — do not attribute it to teething.

What are the real symptoms of teething?

Symptoms reliably associated with teething include: excessive drooling, swollen or tender gums, increased biting and chewing, irritability and fussiness, disrupted sleep, and mildly decreased appetite. A slight temperature rise below 100.4°F (38°C) may occur. High fever, diarrhea, significant vomiting, and body rash are NOT teething symptoms and warrant a call to your pediatrician.

What teething remedies are safe for babies?

Safe teething remedies include chilled (not frozen) teething rings, firm rubber teethers, gentle gum massage with a clean finger, cold soft foods for babies eating solids, and age-appropriate pain reliever as recommended by your pediatrician. Avoid benzocaine gels (like Orajel), teething tablets with belladonna, amber teething necklaces, and frozen hard objects — all pose safety risks.

When do babies start teething?

Teething typically begins between 4–7 months, though some babies start as early as 3 months and others don't see their first tooth until after 12 months — all within the normal range. The lower front teeth usually appear first, followed by the upper front teeth. Most children have all 20 primary teeth by age 3.

Is it safe to use teething gels like Orajel on babies?

No — the FDA advises against using benzocaine-based teething gels in children under 2. These products can cause methemoglobinemia, a rare but serious condition that reduces the blood's ability to carry oxygen. Lidocaine-based products are also unsafe for young children. Stick to physical comfort measures and age-appropriate pain relievers recommended by your pediatrician.

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