Everyone says it's teething, but you're not sure

What teething actually does

Drooling, and a lot of it. Chewing on anything within reach. Sore, sometimes visibly swollen gums. Fussiness and disrupted sleep that comes and goes over a few days rather than steadily worsening. Some children run slightly warm — a tenth or two above their usual — which is not the same as a fever.

The timeline is far wider than the charts imply. A first tooth can appear at three months or after a first birthday, and both are ordinary. The order is more consistent than the timing: bottom front pair, then top front, working backwards, with the molars around a year to eighteen months being the ones that genuinely hurt.

What is not teething

A real fever. Teething does not cause a temperature at or above 38°C/100.4°F, and treating one as teeth is how an infection gets a few days' head start.

Diarrhoea, vomiting, a rash spreading beyond the chin and neck, a cough, congestion, or refusing all fluids. Each of those has its own cause, and the timing coincidence is doing the work — a child is teething for most of two years, so nearly any illness overlaps with it.

The useful test is whether the child is unwell between the moments of obvious discomfort. A teething child is fine in the gaps. An ill one is not.

What helps, and what to skip

Cold pressure is the whole of it: a clean chilled — not frozen — teether, a cold flannel to chew, or a chilled spoon. Firm counter-pressure from a clean finger works for the same reason. For a child on solids, something cold and hard enough to gnaw safely.

Skip amber necklaces entirely: no evidence of benefit, and a genuine strangulation and choking risk on a sleeping child. Skip benzocaine gels — regulators have warned about them for infants — and skip homeopathic teething tablets, which have been recalled over inconsistent belladonna content.

Infant paracetamol or ibuprofen have a place for a genuinely miserable night, at the dose your pediatrician gives you for your child's weight. That is a reasonable tool, not a failure.

When to look past the teeth

Any fever at or above 38°C/100.4°F, and especially in a baby under three months, where it is an immediate call whatever else is happening.

Also worth a call: refusing fluids for a stretch, unusual lethargy, a rash that is spreading, or a level of distress that is not settling with anything. And separately — if no tooth has appeared by about eighteen months, mention it at the next visit. It is usually just late, and that is worth confirming rather than assuming.