Parenting Advice

Guide to Teething

Overview
When will your baby's first pearly white start to poke through? Most babies get their first tooth at around 6 months, but your child's chompers may appear as early as 3 months or as late as 14, depending on such factors as when Mom and Dad started sprouting teeth and whether or not your baby was a preemie
(preemies tend to teethe on the late side). How babies experience teething can vary widely, too. Some have symptoms -- such as excessive drooling and crankiness -- weeks before a tooth actually emerges, while others show no signs at all.

Baby-tooth timeline
Typically, babies get their teeth in pairs. First come the middle two on the bottom. A month or so later, the two above those arrive. Still, it's not uncommon to see a baby with four bottom and no upper teeth, or the reverse. A general timeline:
* 6 months: lower central incisors
* 8 months: upper central incisors
* 10 months: lower and upper lateral incisors
* 14 months: first molars
* 18 months: canines
* 24 months: second molars

Signs of teething
Short of actually seeing a tooth poking through, and given that the process is
different for every baby, some possible symptoms to watch for:

The need to gnaw. The pressure of an emerging tooth beneath the gums may be relieved by counterpressure, so teething babies often want to chomp on things. The chewing instinct may also be a response to the odd sensation that something's going on in there.

Puffy gums. Before a new tooth erupts, it can cause a red, swollen, bruisedlooking area on a baby's gums. Sometimes the gum bulges with the emerging tooth, which you can see faintly beneath the skin (if you can convince your baby to open his mouth for long enough).

Excessive drooling. Increased spittle can herald a new tooth -- but it's also a normal developmental stage of infancy, so don't assume that drooling means teething. There's no way to tell whether your baby's saliva is the result of teething or not, though it may be if you also see... Fussiness, especially at night. Tooth eruption -- when the tooth moves through the bone and gum -- tends to come in stages, with more activity at night than during the day, so your baby may be more irritable then.

Ear pulling. While it can also be a sign of an ear infection, tugging can be a symptom of teething: The pain from the jaw gets transferred to the ear canal. A change in eating habits. Babies who are eating solids may want to nurse or bottle-feed more because a spoon irritates their inflamed gums. Others may do
the opposite, eating more than usual because the counterpressure feels good. And babies who are still on the bottle or breast may begin feeding eagerly but pull back because the activity of sucking puts uncomfortable pressure on the gums and ear canals.

Ways to soothe the pain
You may need to try a few methods to see what works best for your child:
A wet, frozen washcloth (leave one end dry so she can get a good grip). The thick fabric feels good, and the icy cold numbs sore gums. A teething toy that's been chilled in the refrigerator also works, but frozen toys may be too harsh on an infant's sensitive gums. "My daughter, Eliza, loved to mouth the rail of her crib, so to protect her teeth and the crib, I covered the rail with soft plastic strips she could chomp on to her heart's content." -- Maura Rhodes, Montclair, NJ Massage. If the tooth is still deep in the gum and hasn't formed a painful bruise, counterpressure or friction where it's about to erupt can work wonders. Try rubbing the area with your clean finger (bare or wrapped in a washcloth).

Infant acetaminophen and ibuprofen are good bets for temporary pain relief, as are topical oral anesthetics, as long as you don't exceed the recommended dosage.
Distraction. Teething pain is like headache pain -- it causes chronic, lowgrade discomfort. You can often soothe your child simply by getting her mind off the pain. Give her more one-on-one time or offer her a new toy. And don't underestimate the healing power of touch: A little extra cuddling on the sofa
may be all that's needed to take a child's mind off her mouth.

Teething tricks you shouldn't try
Hard foods like zwieback crackers, toasted or frozen bagels, carrots, and frozen bananas. They may appeal to a baby's intense urge to chew, but when gnawed on long enough they can come apart in choke-hazardous chunks. Rubbing a little brandy on swollen gums. Even tiny amounts of alcohol can be
poisonous to a baby.

When to call the doctor
Because some signs of teething may actually be signs of illness, call if symptoms worsen (for instance, a low-grade fever reaches 101° F or higher) or linger for more than a couple of days. Same goes if no teeth have come in by 15 months, in which case your pediatrician may want you to take your child to
a dentist for an x ray.

Summary
The teething process lasts about two years, but after the first few teeth come in, the process tends to be much less painful. (Experts aren't sure why that is -- it could be that babies get used to what teething feels like over time.) Once the first tooth appears, try to start cleaning it twice a day by rubbing gently with a washcloth. Whatever you do, don't put your baby to bed with a bottle or nurse him to sleep once his teeth come in, since he's now prone to cavities. This may be a tough time for your baby (and you), but with
a little help, he'll have a lifetime of happy smiles.