You love watching your baby hit those sweet milestones — the first smile, first giggle, and rolling over for the first time. But one that’s sometimes not so sweet (for you or for them) is cutting their first tooth.

Teething is when a baby’s teeth start to come through their gums. Although this is a typical part of growing for babies, it is one of those milestones that can bring discomfort, tears (from you and baby), and even sleepless nights (yep, more of those!).

As for when your baby will actually start the process, it depends.

A baby’s teeth can sometimes emerge with no pain or discomfort, so you might not realize they’re teething until you see the first sign of a tiny white tooth. For other babies, though, teething does cause discomfort.

Common symptoms of teething may include:

  • drooling
  • face rash from drooling
  • chewing on different objects
  • irritability and crankiness
  • crying
  • refusing to eat
  • swollen, sore, or tender gums
  • trouble sleeping
  • flushed cheeks
  • pulling on their ears
  • slightly elevated temperature to around 99°F (37.2°C)

Symptoms of teething in breastfed babies

Teething symptoms can occur whether you breastfeed or bottle-feed your baby. But if you breastfeed or chestfeed, you might notice other changes, too. For example, gum pain or soreness might cause your baby to latch on differently.

Before a tooth emerges (and even afterward), you might feel your baby gnaw or bite down on your breasts. And since breastfeeding is soothing for babies, they might feed more often while teething.

Keep in mind that teething symptoms occur before a tooth breaks through the gum, so don’t be alarmed if you notice these changes in your baby but don’t see any sign of a tooth.

Most babies get their first tooth between 4 and 7 months old.

But there’s a wide range of when it’s considered “typical” to start teething. So don’t panic if your little one hasn’t cut a tooth by 7 or 9 months old. If you’re concerned, you can always speak with their pediatrician at their next checkup.

To get even more specific, most infants begin teething at around 6 months old. Your little one will likely have a full set of their first teeth by age 3, and all the joys of the teeth-brushing routine will have been long established.

But “typical” doesn’t mean “best” or “all.” Exactly when your baby will start teething may even be hereditary.

And though it may seem impossible, some babies are born with one or two teeth! This occurs in about 1 in 6,000 to 1 in 800 cases — so it’s uncommon. It makes for some incredibly adorable pictures, but let’s be honest — toothless grins are pretty darn cute, too.

Infants born with teeth should have them closely monitored since they can present a choking risk.

Some infants are early teethers — and it usually isn’t anything to worry about! If your little one starts showing signs of teething around 2 or 3 months old, they’re simply ahead of the curve in the teething department. And if your baby is a late teether, try not to worry about this either (easier said than done, we know).

Every baby is different, so don’t be concerned if all your child’s little friends have started to cut teeth already — yours will too, in their own time. In fact, if you’re going to compare at all, it’s better to consider when their siblings (if they have them) got their first tooth.

The bottom two teeth are usually the first to appear, followed by the four upper teeth. So keep an eye on that area and prepare for cuteness overload when they do.

Next, their teeth may come in two at a time, one on each side of the mouth. But this pattern can vary, and many factors can influence the timeline (like if your baby was born early or at a low birth weight, for example).

On average, babies have:

  • 4 teeth by 11 months
  • 8 teeth by 15 months
  • 12 teeth by 19 months
  • 16 teeth at 23 months

Those sometimes distressing (but always perfectly usual) teething symptoms may come and go during this time period. Or they may be more consistent as your little one cuts new teeth or starts to feel the first symptoms of a tooth emerging.

If your child doesn’t have any teeth by 18 months, see a pediatric dentist for evaluation. In rare cases, an underlying medical issue may cause a delay in teething. These may include:

If you’re concerned that it’s been a while since your child cut their last one or two teeth, speak with their pediatrician.

When your little one is teething, you may feel more inclined to reach for that bottle of wine or chocolate bar because it’s tough to see your baby in pain. (No? Just us?)

Well, baby needs some soothing, too.

Home remedies

These are some tried and true — and most importantly, safe — home remedies you can try:

  • Gently massage your baby’s gums with a clean finger, knuckle, or moistened gauze pad.
  • Hold a cold washcloth, spoon, or chilled teething ring on your baby’s gums.
  • Use plastic or rubber toys that are chilled — never frozen solid (ouch!).
  • Offer cold foods like a chilled little slice of cucumber if your baby is already eating solids — but always keep a watchful eye on them, because this could be a choking hazard.

Medical treatment

Currently, there aren’t any medical treatments to soothe teething pain in a baby. The good news, though, is that babies typically respond positively to home remedies.

If these remedies don’t relieve symptoms, feel free to ask your pediatrician about the occasional use of over-the-counter baby acetaminophen or ibuprofen.

Your pediatrician can advise whether this is an OK treatment and provide guidance on proper dosing.

And an important note: No matter how attractive the item or the claims of its manufacturers, avoid teething necklaces or bracelets — worn by adults or babies — made of amber, wood, or silicone. These can quickly turn into choking hazards, and it’s just not worth it.

Also on the no-go list: homeopathic teething tablets and medicated topical gels. The Food and Drug Administration (FDA) has issued warnings against using both of these products.

Medicated topical gels contain the ingredient benzocaine, which is an anesthetic. It’s found in products like Anbesol, Orajel, Baby Orajel, and Orabase.

Benzocaine is linked to a rare but serious condition called methemoglobinemia.

Keep in mind that good oral health isn’t important for only older children, teens, and adults. Your baby’s oral health matters too. So start brushing those pearly whites as soon as the first tooth grows in.

How do you keep their tiny, delicate teeth healthy? There really isn’t much to do at this age, but the first step is to buy an infant toothbrush that is soft and gentle. You’ll brush their teeth twice a day, once in the morning and once at night.

And yes, it’s OK to use a fluoride toothpaste, but not too much. You only need a small grain-size amount until they’re 3 years old; then, increase to a pea-sized amount.

Brushing helps prevent tooth decay, which can occur when sugar from milk, juice, or formula remains on their teeth and damages the enamel.

Have questions about teething? Here are answers to a few frequently asked questions.

What are the first signs of teething?

The teething experience can differ for each individual baby, but some of the first signs include:

  • drooling
  • gnawing
  • trouble sleeping
  • irritability or crying
  • a mild increase in body temperature

Some babies also develop flushness around their cheeks or a rash. And if you breastfeed or chestfeed, teething might change the way your baby latches, or they might feed more often to soothe themselves.

How early do babies show signs of teething?

Teething typically occurs around 6 months of age. However, some babies start teething as early as 2 or 3 months. Then again, some babies teeth later and don’t cut their first tooth until 8 or 9 months (or later).

How long does teething last for babies?

The teething timeframe differs for each baby. But regardless of whether a baby starts teething at 6 months or 9 months, they typically stop teething before age 3. Some babies stop teething around 24 months, while others don’t stop until 36 months.

Do babies get sick when teething?

Even though your baby may have physical discomfort, teething doesn’t make them sick. So if your baby has a runny nose, productive cough, diarrhea, vomiting, or a high fever, these symptoms aren’t associated with teething. This could be a sign of an infection, so speak with their pediatrician.

When your baby cuts their first tooth usually says nothing about their development — as with most things baby, there’s such a wide range of totally OK. Most infants end up with a full set of baby teeth by the time they’re 3 years old, regardless of when they cut that first tooth.

But if your baby hasn’t cut a tooth by the time they’re 18 months old, talk with your dentist. Ideally, you’ve already brought your baby to a pediatric dentist by age 1, as recommended by the American Academy of Pediatric Dentistry (and the American Dental Association and American Academy of Pediatrics, too).

So if you haven’t seen a dentist yet, this would be a good time to have your sweet babe’s mouth and gums checked out.

While visiting the dentist for the first time may sound scary, remember these two things: Your baby hasn’t yet had a negative dental experience to create dread, and pediatric dentists are great at making the visit comfortable — it can even be even fun.

Once your little one does cut a tooth or two, be sure to take good care to clean around the area each day with a damp, cool washcloth or soft-bristle baby toothbrush. Before you know it, they’ll (hopefully!) be brushing their teeth on their own.