Teething and sleep: safe comfort and when it's really illness

A new tooth can mean a few rough nights. Sore gums, extra dribble and a grizzly baby who wakes more than usual are common, and then it usually settles. What teething doesn't do is cause a real fever or make a baby seem properly unwell, and that's the most important thing to know at 2 am. If night waking comes with a temperature of 38°C or more, or your baby just isn't themselves, think illness first.

This guide covers what sources say about teething and sleep, how long a sore spell tends to last, safe comfort at bedtime and overnight, what to avoid, and when to get help. For the order teeth arrive, see the teething timeline; for teething symptoms and relief during the day, see teething.

Does teething really disrupt sleep?

It can, for a short while. The NHS teething guide says most babies start teething at around 6 months and lists "not sleeping very well" among the possible signs, alongside a sore, red gum, a slightly raised temperature under 38°C, a flushed cheek, rubbing their ear, extra dribbling and chewing. Its guide to helping your baby sleep says teething discomfort or hunger may wake some babies between 6 months and a year, and that growth spurts, teething and illness can all affect sleep.

Some teeth arrive with no fuss at all. The NHS says baby teeth sometimes come through with no pain or discomfort.

What does the research show?

One of the largest studies followed 125 healthy babies, with parents recording symptoms every day from the 4-month check until the first birthday. The study, published in Pediatrics in 2000, found:

• symptoms were only more common in an 8-day window: the 4 days before a tooth came through, the day itself and the 3 days after
• more wakefulness, irritability, biting, drooling, gum-rubbing, ear-rubbing and a mild rise in temperature were linked with teething
• what parents recorded as "sleep disturbance" was not significantly linked, nor were congestion, loose poo, cough, vomiting or high fever
• no single symptom showed up in more than 35% of teething babies, and no symptom pattern could reliably predict a tooth

The authors concluded that other causes should be ruled out before putting signs of a potentially serious illness down to teething. In other words, teething can explain a few unsettled nights, but not a baby who is sick, and not weeks of poor sleep on its own.

How long does teething keep a baby awake?

Usually days, not weeks, for each tooth.

The Better Health Channel says changes in sleep and eating, fussiness, drooling and rash are often linked to teething, and that if symptoms go on longer than around 48 hours, it's important to see your doctor to check for other causes. The AAP's teething guide says more crying, more often, may mean your baby is sick and is worth discussing with your doctor.

The Better Health Channel says the average child has all 20 baby teeth by about 3 years, so short sore spells can come and go for a while. The teething timeline shows when each tooth usually arrives.

What doesn't teething cause?

Blaming teething for signs of illness can delay care. These are the limits sources draw:

• Fever. The Royal Children's Hospital Melbourne (RCH) says teething babies may have a temperature up to 38°C, but a temperature above that is not caused by teething and your child likely has an infection. The NHS describes a teething temperature as slightly raised but less than 38°C, and the AAP calls fever a false symptom of teething.
• Diarrhoea. The NHS says there's no evidence teething causes diarrhoea, and the AAP says teething doesn't change the way your baby's gut works. The Better Health Channel lists diarrhoea and a runny nose among symptoms often linked to teething, so sources differ, but all agree diarrhoea can mean infection.
• A baby who seems unwell. Don't put it down to teething if your baby is floppy, much sleepier than usual, struggling to breathe or refusing milk feeds.

How can I comfort a teething baby at night safely?

1. Cool the gums before bed. The NHS teething tips say some teething rings can be cooled in the fridge first, but never put one in the freezer, because a frozen ring could damage your baby's gums. The US FDA recommends a firm teether that isn't liquid-filled and isn't frozen.
2. Rub the gum. The NHS says gently rubbing your baby's gums with a clean finger may help, and the Better Health Channel suggests a clean finger or a soft, wet cloth.
3. Comfort when they wake. The AAP says that if your child wakes often at night or during naps, you can often soothe them back to sleep with light, focused pressure on the gums or a gentle gum massage, or a cold teething cloth. It also warns against letting your baby chew on anything frozen solid.
4. Keep night-time calm. The NHS suggests keeping the lights low, not talking much and keeping your voice quiet at night.
5. Feed if they're hungry. Sore gums can make some babies fussy at feeds. Offer milk as usual and follow your baby's cues.
6. Wipe away dribble. The NHS says gently wiping your baby's face may help prevent a dribble rash, which can add to night-time discomfort.

Keeping teething comfort safe in the cot

• Teethers are for awake time. The FDA says to supervise babies with teething rings so they don't choke, so take the ring away before your baby goes to sleep.
• Nothing around the neck. The NHS says never tie a teething ring around your baby's neck, as it may be a choking hazard.
• The usual safe-sleep rules still apply. Red Nose in Australia says to always place your baby on their back to sleep, keep their head and face uncovered and keep soft items out of the cot. See safe sleep.

Should I give pain relief for teething at night?

Try cooling, gum rubbing and comfort first. If your baby is clearly in pain, a pain reliever may help them settle; the AAP says a night-time dose might ease a fussy, uncomfortable child into sleep, and to ask your doctor about safe use. The NHS teething tips say:

• use a sugar-free pain reliever and always follow the instructions that come with the medicine
• paracetamol can be given from 2 months
• ibuprofen can be given from 3 months, so it isn't for babies younger than that
• children under 16 should not have aspirin

The NHS fever page adds not to alternate paracetamol and ibuprofen unless a doctor or nurse tells you to. Ask a pharmacist which product and dose suit your baby's age and weight, and write down each dose and time, especially if more than one carer is giving medicine. If your baby seems to need pain relief night after night, talk to your GP rather than keep going.

Which teething products should I avoid, especially at bedtime?

Teething necklaces. The FDA has received reports of deaths and serious injuries, including strangulation and choking, caused by teething jewellery such as amber necklaces. The AAP says necklaces made of amber, wood, marble or silicone pose serious choking and strangulation risks. The Queensland Government in Australia says a necklace may tighten around a child's neck, especially while they sleep, and that it doesn't support the use of these products.

Teething gels. Advice differs a little between countries, but none recommends gels as a first step:

• Australia: the Better Health Channel says common teething gels contain choline salicylate, which is related to aspirin, that a toxic dose is possible, and that gels may not relieve teething pain. It calls them a risk not worth taking.
• US: the FDA says benzocaine and lidocaine products shouldn't be used for teething pain because they can be dangerous, and the AAP says numbing gels usually aren't helpful because drool washes them away.
• UK: the NHS says there's a lack of evidence that teething gels work, to try teething rings or sugar-free pain relief first, and that general mouth-pain gels aren't suitable for children.

How do I keep sleep routines steady during teething?

A sore spell is a good time to keep things familiar rather than start something new.

• Keep the same bedtime routine. The NHS says a simple, soothing bedtime routine, such as a bath, night clothes and a fresh nappy, a story, dim lights and a cuddle, may help babies settle. The RCH night waking fact sheet suggests a consistent, predictable evening routine so your child knows what to expect.
• Add comfort, not new habits. Extra cuddles and gum rubbing are fine. Many families find it easier afterwards if the baby still goes back into their own cot for sleep.
• Hold off big changes. If you were planning to start a settling plan, night weaning or a room move, a few days' wait until the tooth is through often makes it easier for everyone.
• Go back to normal once it passes. The RCH says setbacks can happen for reasons such as developmental shifts or illness, that it's okay to pause the routine while a child is sick, and that going back to it can feel harder at first but is likely to get better with time.

For ways to respond to waking without creating new sleep associations, see night wakings and bedtime routine. If teething and a sleep regression seem to overlap, sleep regression ages may help.

When is night waking illness rather than teething?

Think illness rather than teething if night waking comes with a temperature of 38°C or more, a cough, a runny nose with a temperature, vomiting or diarrhoea, fewer wet nappies, refusing feeds, or crying that sounds different from usual. Teething also isn't the likely cause if your baby is still unsettled after several days. See sleep when your baby is sick for helping a sick baby rest safely, and fever in babies for temperatures by age.

Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) now if your baby:

• is struggling to breathe, breathing very fast, grunting or sucking in at the tummy or ribs
• has blue, grey, very pale or blotchy skin, lips or tongue
• is floppy, much sleepier than usual, hard to wake or can't be woken
• has a weak, high-pitched or continuous cry, or a cry that doesn't sound like their normal cry
• has a rash that doesn't fade when you press a glass on it, or has a seizure
• has had no wet nappy or wee for 12 hours
• is under 3 months and has a temperature of 38°C (100.4°F) or higher, or is 3 to 6 months old and has a temperature of 39°C (102.2°F) or higher

These come from the NHS urgent-help guide.

Get medical help today (same-day GP, after-hours doctor or a health advice line (Pregnancy, Birth and Baby on 1800 882 436 in Australia, NHS 111 in the UK, your pediatrician's after-hours line in the US)) if your baby:

• is refusing feeds or feeding much less than usual
• has fewer wet nappies than usual; the RCH dehydration fact sheet says a baby under 6 months with any sign of dehydration should see a doctor
• has a temperature and is not their usual self, or you're worried, as the NHS fever page advises
• has had a temperature for 5 days or more
• has diarrhoea that lasts more than a day, which the AAP says is a reason to call your doctor

Talk to your GP or child-health nurse if teething symptoms last longer than around 48 hours, your baby is crying more than usual most days, ear rubbing or night waking keeps going after a tooth is through, or you're struggling to cope with broken nights. You can also call a parenting support service (Tresillian or Karitane in Australia, your health visitor in the UK, your pediatrician's office in the US).

What's worth noting during a teething spell?

Jot down the date you first see each tooth, which nights are unsettled, any temperatures with the time, and any medicine with the dose and time. Over a few teeth, you may see whether sleep dips only around a tooth coming through, or whether something else is going on. That record is also useful to show your GP.