Teething can feel so tricky for parents.  On the one hand, teething is often the first thing that comes to mind when sleep goes awry. For good reason- it really can impact sleep in a big way. But it’s not always the culprit. So how do you actually know? Is it teething that’s getting in the way of your baby’s sleep? Or is it something else? And why does it feel so hard to figure it out?

The first thing to do is to know what true teething symptoms are. And to know what symptoms are not teething-related. 

Teething Symptoms

Teething symptoms typically happen for a few days before and after the eruption of each tooth. They don’t last for weeks on end. 

When does teething start?

While some babies teeth earlier or later, teething usually starts around 4-6 months. At around 2-3 months, the salivary glands reach their full capacity – and that’s when babies start to drool a lot more. Parents often assume drooling equals teething, but it’s not always the case! At this stage, babies also begin to bring their hands to their mouths, which can seem even more like teething! 

Here are the general time frames you can expect to see some new teeth in that tiny mouth. Remember that all babies are unique and develop on their own timeline. So don’t stress if your baby doesn’t match these numbers!

As you can see from this chart, teething happens on and off for your baby’s first 3 years of life. Some teeth come in at the same time, and some teeth pop up without any symptoms or warning. Babies don’t have disrupted sleep for three years solely due to teething. Sometimes, teeth can come in back-to-back, which will cause a longer teething period, but even that won’t be more than a couple of weeks at most.

How Teething Disrupts Sleep

Some babies seem to do ok during the day and only get really fussy at night while in a teething stage. This can happen because at night

• babies are less distracted at night in the dark
• they’re eating/breastfeeding/bottle feeding less
• laying flat increases teething pain 
• cortisol levels (anti inflammatory hormone) are lower at night 

All of these reasons can contribute to a baby who doesn’t seem too bothered during the day, and has a much harder time at night during a teething stage.

Classic Teething Remedies

• Tylenol as directed by your pediatrician
• Motrin as directed by your pediatrician. This has anti-inflammatory properties and lasts longer than Tylenol, but can only be given to babies over 6 months.
• Teething toys 

Unsafe Teething Remedies

• Motrin for babies under 6 months 
• Amber necklaces- choking and strangulation hazard
• Numbing gels (often contain benzocaine, a very harmful ingredient)
• Teething toys with gel filling (these can explode and baby can ingest the filling)
• Popsicles for babies under 6 months (wait till baby can hold independently)

Natural Teething Remedies

• Gum Massage, with or without gum oil
• Wet washcloth kept in freezer for 30 minutes
• Freezable Pacifiers
• Breastmilk Popsicles
• Homeopathic remedies (check with your pediatrician before using), I love this one. More options here and here.
• Lots and lots of extra breastfeeding! 
• Skin to skin time
• Contact napping so baby can lay upright (teething pain is worse when baby is laying flat)

How to optimize sleep during a teething stage:

I know how hard this stage can be, and it only feels harder when you’re not getting much sleep.

It’s important to remember that when our babies are teething, they really are suffering. We need to offer them support and compassion while we all try and get some sleep. Here are my best tips to optimize sleep during a teething stage:

Pain relief before bedtime

Whether you’re going the natural route or using traditional medication, it can be helpful to offer your baby pain relief 30 minutes before bedtime. This allows some time for the relief to kick in so that baby won’t feel distress at bedtime. Do this under the guidance of your pediatrician. 

Sleep is the best medicine

Research shows that when we don’t get enough sleep, we’re more sensitive to pain. Helping your baby get sleep can make the teething stage more bearable for them. This may mean supporting your baby in ways that you usually don’t, such as extra night feedings or bringing them into your bed. 

Maintain Routine 

Keep a consistent naptime schedule and bedtime routine for your baby. No, sleep will not always follow – that’s to be expected. Holding the framework in place for your baby will give more opportunity for sleep and maintain a baseline that you can return to once the teething pain fades. 

Anticipate nights based on daytime demeanor

Often, daytime behavior will give you a clue as to what’s coming at night. If your baby is fussy, warm and irritable during the daytime, get into bed early – it may foreshadow more frequent wakings that night. 

Keep context in mind

Research shows that teething symptoms last 24-72 hours before the tooth erupts. Practically, this means 2-3 rough nights. (Once you see the head of the tooth poking through, we presume most of the pain has passed). If your baby is waking frequently for weeks at a time, that’s likely not teething-related.

In short, teething is real, and it can cause real distress to your baby. And it doesn’t last for weeks at at a time. If you’re struggling with fragmented nights for weeks on end, be sure to check out my Baby Sleep Course, for babies 4-24 months. In this course you’ll learn a step-by-step customizable plan for better nights with no Ferber or Cry It Out methods. You can find that here.