Teething and sleep: what's really teeth, and how to help

When a baby starts waking more, teething is often the first explanation people reach for. Sometimes it’s right. Often, teeth are getting the blame for a developmental leap, a cold or a nap that needs adjusting.

Here’s how to tell the difference, and how to help when it really is teeth.

When do teeth come through?

The NHS notes that most babies start teething at around 6 months, though some start before 4 months and others after 12 (NHS). A rough order:

Teeth	Usually around
Bottom and top front teeth (central incisors)	6 months
Teeth either side (lateral incisors)	8 months
First molars	12 months
Canines	18 months
Second molars	24 months

Most children have all their baby teeth by 2 to 3 years.

What does teething actually do to sleep?

The best study we have followed 125 babies from 4 months to their first birthday, with parents recording symptoms and temperatures every day. Across nearly 500 teeth, symptoms were concentrated in an 8-day window: the 4 days before a tooth came through, the day itself, and 3 days after (Macknin et al., 2000).

In that window, babies were more likely to be wakeful, irritable, drooling, biting, gum-rubbing and ear-rubbing, and some had a mild rise in temperature. But no single symptom showed up in more than about a third of teething babies, and teething wasn’t linked to high fever, cough, congestion, vomiting or loose stools.

So teething can disturb sleep, but usually for a few days around each tooth, not for weeks at a time.

Signs it might be teeth

• Red, swollen or sore gums where a tooth is coming
• More dribbling, chewing and gnawing
• One flushed cheek or a facial rash
• Ear-rubbing on the same side as the tooth
• Being more fretful than usual, and not sleeping as well
• A slightly raised temperature, below 38°C

(NHS)

Signs it’s probably something else

• A temperature of 38°C or above
• Diarrhoea, vomiting, a cough or a runny nose (the NHS says there’s no evidence teething causes diarrhoea)
• Being very unwell, floppy, unusually sleepy, or refusing feeds
• Broken sleep going on for weeks with no sign of a tooth

If you’re unsure, contact your GP, public health nurse or health visitor, or call 111 in the UK.

How to help a teething baby sleep

Soothe the gums before bed

• A teething ring, cooled in the fridge (never the freezer) (NHS).
• Gently rubbing their gums with a clean finger.
• For babies over 6 months, something cool and safe to chew at teatime, such as soft melon, while supervised.

Pain relief, if needed

The NHS says sugar-free paracetamol can be given from 2 months, and ibuprofen from 3 months, for teething symptoms. Follow the dose for your child’s age, and ask a pharmacist if unsure. Never give aspirin to children under 16 (NHS).

The NHS notes there’s a lack of evidence that teething gels work, and that general adult oral pain-relief gels aren’t suitable for children. Homeopathic teething products aren’t recommended.

Offer extra comfort, and keep the routine

Extra cuddles, an extra feed, a little more help to settle: all fine for a few nights. Keep the bedtime routine the same so there’s something familiar to come back to.

The HSE suggests pausing any work on independent settling while your child is ill or teething, and picking it back up once they’re better (HSE).

Getting back on track

Once the tooth is through and your baby’s in better form, gently return to your usual routine. If the extra help you gave during teething has become a new nightly habit you’d like to change, it usually fades within a week or two with a calm, consistent approach. See sleep regression ages for more on riding out the wobbles.