The Truth About Teething And Baby Sleep

The first signs of teething arrive around 4 months when your baby will start drooling like Niagara Falls and be constantly shoving her hands in her mouth.

When I saw these signs, I was excited and proud that a tooth was coming! And then I waited and waited and waited….

My anticipation was a rookie mistake, as most kids will drool like that for about 2 months until the first tooth actually materializes, generally around 6 months.

Listen to the podcast

Chronic Teething vs Acute Teething

There are large variations in tooth appearance related to your genetics, but most of us will overestimate the arrival of that first tooth, which will be the bottom middle teeth aka lower central incisors. I refer to this stage of teething as chronic teething, when we are waiting, seeing all that drool and have no rewards.

Acute teething occurs when the tooth is piercing through the gums. This is the most painful part of teething and usually, lasts 1-2 days. It’s a hard diagnosis to make since you can’t be 100% sure that the pain / poor sleeping is related to teething until the tooth pierces through the gum and you can see it, and by then the pain is receding. It is a hindsight diagnosis.

How does teething interrupt your baby’s sleep?

Your baby surfaces from a sleep cycle and is distracted by the discomfort in her gums, and can’t relax to drift back off into sleep. It’s the same way she would be unlikely to fall back asleep if she had a messy diaper, or if she was learning a new motor skill and thinking about that skill.

https://www.mouthhealthy.org/en/az-topics/e/eruption-charts

COMMON TEETHING TIMES THAT CAUSE BLIPS IN BABY SLEEP:

6 MONTHS – MIDDLE BOTTOM TEETH AKA CENTRAL INCISORS

9- 11 months – A boatload of teeth coming in – upper front teeth, upper lateral teeth, and bottom lateral. There is a very long stretch of early morning wake-ups around 5 am in these months related to the onslaught of teeth coming through.

15 months – first molars generally appear around this time. Where your child’s hands may be in her mouth consistently. The most common sleep disruption at this stage is at bedtime, and early wake-ups, naps aren’t as affected as much.

2 years – Second molars. There’s more variation as to when these may appear, anywhere from 2-2.5 years. And these are a doozy. They are also aligned with The 2-Year-Old Sleep Regression.

What are the signs and symptoms that your baby is teething?

Tender and swollen gums. You can look in their mouth and you can usually see the little white tooth beneath their gums.
Fussiness and crying. Your baby can seem really irritable
A slightly raised temperature (less than 101°F or 38°C)
Putting toys, or fingers in their mouth to provide relief
Drooling. This one can sometimes be difficult to tell if it is attributed to teething itself because many babies drool A LOT when they are not teething
Short 30-minute naps, where your child was previously napping consistently for at least 45 minutes or more.
Trouble settling at bedtime, when your child was previously, settling easily without any help.
Night wakings where she was sleeping uninterrupted or with only 1-2 night wakings.
Early morning wake-ups, before 6 am. There are other things that cause EWU (early wake-ups).

What are NOT signs of teething?

Fever over 101°F or 38°C
Cough
Diarrhea –although your baby MAY have slightly looser bowels, you need to monitor carefully so that you don’t mistake true diarrhea if you need to check with your pediatrician.
Vomiting
They are congested or have a cold

Please note that teething does not make your baby sick. If your baby is showing signs of sickness, you need to take your baby to your pediatrician for a check-up.

Most common misconceptions that parents blame teething for:

Fever
Diarrhea
Drooling (babies can start drooling from around 3 months of age)
Putting objects in their mouth. Yes, this CAN be a sign of teething however it is the most common way that babies are exploring their new world. They try to put EVERYTHING in their mouth!
Loss of appetite (usually only 1-2 days)

What can you do for your baby to help relieve teething:

Chewing toys to help relieve their gums can really provide relief for your little one
Dipping a washcloth (just the end section) into water or breastmilk and then putting it in the freezer for 30 minutes to make it cool (NOT frozen). Also, ensure that you have a good part of the washcloth not wet so your baby can hold onto the dry section easily.
Putting a little bit of pressure on your baby’s swollen gums (make sure you wash your hands just before you do this)
Pain relief: Please talk with your pediatrician based on your baby’s age and symptoms for recommendations for any pain relief they may prescribe.

There is no doubt that teething affects your child’s sleep, but it is not nearly as much as most people think.

The classic misinterpretation of teething goes something like this:

“My baby is 7 months old, never been a great sleeper, but now she’s waking up every 3 hours at night. I’m pretty sure she’s teething. I can just wait this out, right?”

These types of questions are hard to answer because I need so much more information. I need a full history to sort out what is really happening here.

Most importantly, I have to find out if she ever fell asleep by herself and if she’s ever been able to sleep 11-12 hours with 2 or less night wakings. The answer is usually no.

Often what happens at 7-10 months, is that what you were previously doing, becomes less effective in getting your child to fall or stay asleep. Often the parent will start to see waking every 3 hours at night. This is a sign that your child’s in a cycle of being overtired, and waking up after a 3-hour nighttime sleep cycle. These kids usually need help falling asleep at bedtime, either by nursing or rocking, and then needs that same help falling back asleep.

But from Mom’s perspective, she maybe didn’t wake up this much before OR because she’s getting older. Mom expects her baby to be sleeping longer stretches. When she doesn’t sleep longer stretches and sees a finger in the mouth here or there, she assumes that this must be teething being the cause of bad sleep. Okay okay… I’m making a TON of generalizations here… and yes there are deviations, but this is the majority of issues that I see at this age. I’m hoping you can roll with me.

Can you sleep train (teach) when your baby is teething?

Obviously, we would love to avoid teething when we are working on your child developing a new skill – the skill of relaxing herself into sleep without rocking, nursing, or a pacifier. The best time to sleep train is when there are the least amount of variables at play. Variables such as teething, motor development, life change, etc. However, that chronic teething is going to go on for months, and you will reach a point where you and your child, just REALLY NEED SLEEP!

And let’s not forget that chronic teething isn’t really that uncomfortable, but ACUTE teething is. Remember how long that acute teething lasts? Right, usually just 1-2 days. So avoid those 1-2 days and then GO FOR IT, with respect to sleep training.

When it comes to teething, I am all about pain medication for my kid for that acute period. This is because they (and I) need sleep and comfort, and that’s one variable that I can control. You should talk to your pediatrician about the best options for your family.

Moral of the story:

Yes, teething derails things a bit, but it is not as long as one might think. It is not a reason to continuously delay sleep training (teaching) a poor sleeper. You could be waiting for a long time since poor sleeping is minimally related to the teeth.

Share your thoughts on Teething and Sleep in the comments below. Want to add something? Feel free to share.

If your baby or toddler is struggling with sleep, send me an email or set up a discovery call! I am here for you!

Sending sleepy vibes and sweet dreams your way!

Erin McCormick

Your Pediatric Sleep Consultant