Teething

🧭 When to suspect

Teething is the normal eruption of the primary (milk) teeth through the gums, and it is fundamentally a clinical diagnosis of exclusion. Most infants are affected between 6 and 24 months, with symptoms clustering in the few days around each tooth breaking through. The genuine features are mild and localised – drooling, gum-rubbing, a desire to bite and chew, irritability, disturbed sleep, a flushed cheek, and a drool rash on the chin.

The single most important principle is that teething does not cause significant illness. A high fever (≥38°C), diarrhoea, vomiting or a productive cough must never be attributed to teething until other causes – otitis media, UTI, lower respiratory infection and meningitis – have been considered and excluded. The key skill in primary care is therefore twofold: recognise the benign pattern, and never miss the unwell child hiding behind a teething label.

Bottom teeth usually erupt before the matching upper teeth, and most children have all 20 milk teeth by 2–3 years. Timing varies widely – some infants teethe before 4 months and a few not until after 12 months, and occasionally a baby is born with a tooth.

Source: NICE · NHS