Discomfort associated with teething in infants is common. Many babies' teeth come through without any problems other than increased dribbling but for some, teething can make them mildly unwell and irritable.
Teething may cause your baby to be a little off colour but it doesn't cause serious illness. Take your child to the doctor if they have a high temperature, diarrhoea, sore ears, are not drinking or seem to be unwell (rather than just grizzly).
For further information and support talk to your doctor, pharmacist, practice nurse or Plunket nurse. You can also phone Healthline free (within New Zealand) on 0800 611 116 for health advice. Calls are answered by registered nurses or other health professionals.
When does teething begin?
Most children will get their first tooth between the age of 6 and 10 months, although some children will be earlier and some later. The lower (bottom) front teeth usually come through the gum first. These are followed by the upper (top) front teeth. The picture below shows when each tooth usually appears.
Image credit: Ministry of Health, NZ
What happens when a tooth erupts (breaks through)?
The skin over the tooth may become red and swollen, and look tight and shiny. Some children find this painful. For others it is only a minor irritation.
For some children, teething also causes low-grade fever, loss of appetite, dribbling, upset stomach and/or skin rashes. The child may be grizzly and hard to please when awake, and have difficulty sleeping. Teething should not make your child very unwell, so symptoms such as diarrhoea or high fever should not be seen as a normal part of teething.
What can I do to soothe my baby's painful gums?
Giving your baby something cold to suck or chew on can help relieve the pressure and soothe inflamed gums.
- If they have started solids a chilled banana may be soothing, but watch closely because of the risk of choking on small bits.
- Some babies like sucking on a flannel that has been moistened and put in the freezer for a few hours.
- You can also buy solid, silicon-based teething rings that you cool in the fridge (not freezer – too cold) and give to your child to chew on.
- Don't dip them in sweet substances such as honey or syrup as this may lead to dental cavities. Teething biscuits and rusks that contain sugar are not recommended.
Also try gently but firmly massaging or pressing on your baby's gums, using a clean finger or soft cloth. If this obviously upsets your child do not continue.
(NHS, UK, 2015)
Can I give my baby paracetamol?
Yes, if needed you can give your baby liquid paracetamol to control pain. Weigh your baby and check the dosage information on the package. Give them the correct dose based on their weight and don't exceed 4 doses in 24 hours. Ask your doctor or pharmacist if you're unsure how much to give your baby. Read more about paracetamol for children.
Should I use teething gels?
Teething gels such as Bonjela can be bought over the counter at your pharmacy. They contain a mild anaesthetic to help ease pain. Follow instructions and avoid overuse – read about safe use of Bonjela.
There is little evidence that teething gels are effective in reducing the pain and discomfort associated with teething. This may be because most of the gel is likely to be quickly removed by the tongue and saliva.
|WARNING: Safe use of Bonjela – using too much can harm your baby|
If using a teething gel such as Bonjela, follow the directions on the package or ask your pharmacist. In New Zealand, Bonjela teething gel contains a mild pain reliever called choline salicylate – this can be very harmful to your baby if too much is given.
Check the age restriction: this is either on the package or ask your pharmacist, eg, should not be used in children aged less than 4 months old.
Do not exceed the recommended dose: follow the dosing instructions on the packaging or ask your pharmacist about how to use the gel correctly. The dose for Bonjela is to rub a small quantity of gel (a pea-sized amount, or cover the tip of your index finger) to the affected area no more than every 3 hours and do not use it more than 6 times in 24 hours. You can overdose your baby by applying too much gel or using it too often.
Keep all medicines out of sight and reach of children
|SIGNS OF OVERDOSE include vomiting, unusual sleepiness, fever and rapid breathing. Call Healthline free (within New Zealand) on 0800 611 116 or see your doctor urgently if you are concerned about your child or think accidental overdose may have occurred.|
Avoid teething necklaces due to risk of strangulation or choking
Necklaces made from amber beads have been gaining popularity for use in babies who are teething. It is claimed that the amber soothes the pain of teething when worn next to the skin. These necklaces are not recommended as there is no evidence that amber offers effective pain relief and they pose a serious risk of choking or strangulation.
If you choose to use this device, you must supervise your baby at all times (including sleeping) while wearing the necklace.
How do I protect skin vulnerable to rashes?
To help prevent rashes on the face, use a warm, clean flannel to gently wipe away dribble and then apply a protective ointment like Vaseline or lanolin.
Some children are more susceptible to nappy rash when they are teething. Change dirty nappies regularly, and wash the baby's skin with warm water and mild soap after each bowel motion. Applying a barrier cream or ointment will also help protect baby’s skin.
- Common issues in paediatric oral health BPAC, NZ, 2010
- Topical oral choline salicylate gels – safety in children Medsafe Prescriber Update, NZ, 2009
- Choline salicylate New Zealand Formulary for Children, 2019