The Real Signs of Teething and How to Tell Them Apart From Something Else
In this article
- Teething symptoms as told by science
- Symptoms that are not caused by teething
- Unexpected symptoms reported by some parents
- How long teething symptoms last
What the Research Actually Links to Teething
One of the best-known prospective studies on teething symptoms was carried out by Macknin and colleagues at the Cleveland Clinic, tracking 125 children across 475 tooth eruptions. The study found that several symptoms were statistically associated with teething, though none occurred in more than 35 percent of teething babies (Macknin et al., 2000). This is an important point: teething symptoms are real, but they are not universal, and they are milder than many parents expect.
The symptoms most consistently linked to teething across clinical research include:
· Increased drooling and dribbling
· Swollen, red, or sensitive gums
· More biting and chewing on objects, fingers, or hands
· Irritability and fussiness
· Gum rubbing
· Mild sleep disruption
· Decreased appetite for solid foods
· A slight rise in temperature (but not a true fever)
A larger review published in the journal Pediatrics confirmed these findings and added that facial rash around the mouth, caused by excessive drool irritating the skin, and ear rubbing on the same side as an erupting tooth were also commonly reported (Massignan et al., 2016). The NHS lists similar symptoms, noting that babies may also have flushed cheeks and want to chew on things more than usual (NHS).
The Symptoms Teething Does Not Cause
This is where the biggest misconceptions lie. Many parents and even some older health resources attribute high fever, diarrhoea, vomiting, and widespread rashes to teething. The clinical evidence does not support these links.
A systematic review and meta-analysis examining the relationship between fever and primary tooth eruption found that while teething may cause a slight rise in body temperature, it does not typically cause a clinically significant fever (generally defined as 38°C or above in infants) (Memarpour et al., 2015). The NHS is clear on this point: symptoms such as a high temperature, diarrhoea, and vomiting are not caused by teething, and a baby showing these signs should be assessed by a healthcare professional (NHS).
The danger in blaming these symptoms on teething is that it can delay parents from seeking help for genuine infections or illness. Ear pulling, for example, can be related to teething discomfort but is also a classic sign of an ear infection. If your baby has a temperature above 38°C, is persistently vomiting, has watery diarrhoea, or seems generally unwell, these symptoms warrant medical attention regardless of whether your baby is also teething.
The Unexpected Symptoms Parents Notice First
Parent discussions online often mention less formal symptoms that are not well captured in clinical studies. Some parents described symptoms they had not expected, including changes in nappy contents, unusual breath smell, increased clinginess, and what one parent described as a kind of low-grade restlessness that lasted for days before a tooth appeared.
Some of these observations align with what researchers have found. The slight temperature increase associated with teething can make babies feel generally unsettled. Increased saliva production can sometimes cause looser stools, though this is not the same as clinical diarrhoea. And the discomfort in the gums can make babies seek more physical comfort, which parents often notice as sudden clinginess or a reluctance to be put down.
Other parents notice their baby’s chewing becomes more intense and purposeful during active teething. Babies may chew on their own fingers, on toys, on clothing, or on anything they can get into their mouth. This is a natural response to gum pressure and is also part of healthy oral development. Offering something safe and firm to chew on, such as a chilled teething ring or a hard teething biscuit designed for infants, gives babies a way to manage the discomfort themselves, which some paediatric feeding specialists believe may help babies practise chewing movements and oral motor coordination.
How Long Teething Symptoms Last and Why They Come in Waves
One of the most frustrating aspects of teething for parents is how long it seems to go on. Many parents report weeks or even months of on-and-off symptoms before a tooth actually breaks through. Research suggests that symptoms tend to peak in the days immediately before and during eruption, typically lasting around eight days per tooth: four days before, the day of eruption, and three days after (Massignan et al., 2016).
However, because babies often have several teeth coming through in overlapping phases, it can feel like the symptoms never stop. Molars, which are larger and break through a wider area of gum tissue, tend to cause more discomfort than incisors. Parents frequently describe molar teething as significantly harder than the front teeth, with more sleep disruption, more fussiness, and more chewing.
This stop-start pattern also makes it difficult to tell teething apart from minor illnesses or ordinary developmental changes. Babies who are teething may still be irritable, but they usually continue to interact, drink fluids, and recover between periods of discomfort.
When to See a Doctor Instead of Waiting It Out
Teething is uncomfortable but it is not an illness. The NHS recommends seeking medical advice if your baby has a temperature above 38°C, persistent diarrhoea or vomiting, unusual swelling or discharge from the gums, or any symptoms that feel severe or out of character (NHS). If your baby seems to be in significant pain that is not eased by gentle gum rubbing or a teething ring, a pharmacist or GP can advise on appropriate pain relief such as infant paracetamol or ibuprofen.
It is also worth remembering that teething coincides with the age when babies lose some of the passive immunity they received from their mother, meaning they become more susceptible to common infections. A baby who is teething and also happens to catch a cold or a stomach bug can look very unwell. In these cases, have a healthcare professional check them rather than assuming everything is down to teething.
