Quick answer: Chilled (not frozen) teething rings, firm gum pressure from a clean finger, and appropriate-dose paracetamol or ibuprofen are the most effective approaches. Teething gels with lidocaine or benzocaine are not recommended for babies.
What teething pain actually involves
Teething discomfort comes from inflammation in the gum tissue as the tooth crown pushes through. The inflammatory process peaks in the 1–4 days before and during eruption, then resolves. Most symptoms — increased drooling, gum rubbing, mild sleep disruption, low-grade temperature up to 37.9°C — cluster around the actual eruption window. The molars (typically erupting 13–19 months) are generally the most uncomfortable because of their larger surface area. Many parents attribute weeks of general unsettledness to teething when the correlation is coincidental — unsettledness in infancy has many causes, and developmental leaps, sleep regressions, and illness are often the real drivers.
Cold and pressure: the two mechanisms
Teething discomfort responds to two things: cold (reduces inflammation) and counter-pressure (provides sensory input that competes with the pain signal — the gate control theory of pain). Chilled teething rings (refrigerate for 30 minutes, not frozen — frozen is too hard and can damage gum tissue) provide both. A clean adult finger pressed firmly along the gum provides counter-pressure without cold. Chilled soft foods (cucumber sticks, cold banana) work for babies who are already on solids. The pressure from firm chewing on an appropriate teether is more effective than light gnawing.
Pain relief: what works
Paracetamol (Calpol) or ibuprofen (Nurofen for Children) at the correct weight-based dose are effective for teething pain. For night-time discomfort: a dose given at the start of the bedtime routine (rather than waiting until the baby is screaming at 2am) produces better sleep outcomes. Ibuprofen has mild anti-inflammatory effect in addition to pain relief — for the inflammatory mechanism of teething, this is an advantage over paracetamol alone. The standard cautions apply: paracetamol from 2 months; ibuprofen from 3 months.
What not to use
Teething gels containing lidocaine or benzocaine (local anaesthetics) are not recommended by the MHRA (UK), FDA (US), or AAP. The reasons: topical application is inconsistent (baby salivates and swallows the gel rapidly, reducing local effect); overdose risk exists with repeated application; benzocaine specifically has been linked to rare but serious cases of methaemoglobinaemia (a blood oxygen-carrying problem). In the UK, Bonjela for adults contains salicylates (aspirin-derived) and must not be used on babies. Use only products specifically labelled for infants, and check the active ingredients before application.
Night-specific strategies
For a baby who is clearly in teething pain at night: assess the temperature first (teething doesn’t cause fever above 100.4°F (38°C) — if there is significant fever, a cause other than teething is more likely); give appropriate-dose paracetamol or ibuprofen; offer a chilled teether; and accept that this phase is temporary. Most teething episodes last 3–5 days per tooth. Sleep disruption during active eruption is normal and resolves when the tooth is through.
Frequently Asked Questions
Can teething cause a high fever?
No — this is one of the most important teething facts. Teething may cause a very slight temperature elevation (up to 37.9°C), but a fever of 100.4°F (38°C) or above is not caused by teething. If your baby has a genuine fever (100.4°F (38°C)+), look for another cause — ear infection, viral illness, UTI — and contact your doctor if the baby is under 3 months or the fever is high and persistent.
Do amber teething necklaces work?
No — there is no evidence that amber teething necklaces reduce pain. Succinic acid (the proposed active mechanism) does not absorb through the skin in meaningful amounts. More importantly, teething necklaces present a genuine strangulation and choking hazard. Several infant deaths have been associated with them. Major paediatric organisations advise against them.
My baby is drooling a lot — is that always teething?
Increased salivation begins around 2–3 months as salivary glands mature — well before most babies cut teeth. Drooling at 3 months is likely salivary gland maturation, not teething. When drooling is accompanied by gum rubbing, chewing objects, and irritability — that’s more likely to be teething.
Related Reading
- Teething timeline: when teeth come in and how to help
- 6 month old baby: starting solids – a complete first-foods guide
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