It’s hard to predict when your baby will cut his first tooth, but you can start looking out for teething symptoms around five months. Some babies teethe earlier, some later. Heredity plays a part, so if you check mom’s records, your baby’s teething schedule may resemble yours.

Babies are actually born with a full set of twenty primary teeth. They are 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.  Girls teethe slightly earlier than boys.

The “rule of fours” is how teeth usually appear, explains Dr. Sears. 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.

This chart is from My Child Health:

Here are some practical tips from Dr. Sears to help you and your baby get through this stage:

SIGNS YOUR BABY IS TEETHING

It is sometimes difficult to tell if a baby is teething because the amount of teething discomfort varies considerably among babies. A good way to find out is 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.

• Bulging gums – you can actually see the outline of the teeth as they are bulging inside the gums. The middle bottom teeth are usually the first place this happens. 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, and is best treated by cool compresses (for example, popsicles), which soothe the swelling.
• Gum-massage test. Your baby may be more likely to accept a finger probing into his 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.
• Drooling – it will seem like someone left a “drool faucet” on inside your baby’s mouth.
• Fussing – baby often will become cranky and more difficult to console.
• Night waking – most babies sleep fairly well between one and four months of age, but now the honeymoon is over! Beginning around four months of age, baby may start waking up much more frequently at night.
• Biting – baby will start chewing on everything he can get his hands, or gums, on – his fingers, your fingers, toys, and especially the breast.

REMEDIES FOR TEETHING

• Anything cold – here are a variety of cool favorites:
  • Frozen teething rings
  • Ice – rub an ice cube along baby’s gums.
  • Frozen juice slushy or popsicle
  • Cold spoons
  • Frozen bagel or banana
  • Frozen washcloth
• Medications
  • Acetaminophen or Ibuprofen– these are both safe and effective pain relievers to help your baby, and you, get some sleep. Click on these for dosing.
  • Teething gels– there are various over-the-counter gels, pastes, or liquids that numb the gums. Pat the gums dry with a washcloth, then apply a small amount only on the area of the gums that is bulging. There are several drawbacks to these, so we suggest you only use them as a last resort:
    • They taste terrible
    • They travel throughout the mouth in the saliva and can numb the tongue and lips
    • It is easy to use too much
    • Baby may swallow too much

4 TEETHING SYMPTOMS THAT ARE HARMLESS

There are several symptoms most babies exhibit during teething that may worry you. Don’t be concerned, these are only temporary.

• Drool rash – your baby may get a red, raised rash on the face, lips, chin, neck, and chest. Gently wash with warm water and pat dry. A lanolin ointment is a good treatment.
• Diarrhea – this is generally mild and does not require any special treatment.
• Cough – the abundance of saliva often drips down baby’s throat and can cause coughing or gagging.
• Fever– baby may experience low-grade fevers less than 101. If your baby has a fever higher than this, click on fever for more info.

IS BABY SICK OR TEETHING?

If baby seems cranky or running a fever for no apparent reason, many parents attribute it to teething. Here are some general ways to tell the difference between teething and an illness such as an ear infection:

1. Discharge: Thick, yellow mucis meas baby has a cold, allergy, or infection, especially if accompanied by eye drainage. Teething mucus is clear and doesn’t run out the nose.

2. Fever: Teething rarely causes a fever higher than 101° F (38.3° C).

3. 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. Intensifying: Babies don’t act progressively sicker with teething. As a general rule, when in doubt, have your doctor check it out.