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Teething

Cutting teeth isn't one of those milestones a baby reaches all at once. Transitioning from that gummy grin to a mouthful of gleaming teeth is a rite of passage that can take your child the first three years to complete. By the time he's 3, he'll have a mouthful of choppers that he can brush himself, a basic step on the road to self care. (Because he won't have the skills to do a good job, though, be sure to lend him a hand until he's at least 6 years old.)




When it develops

The journey starts in the womb. While you were pregnant, your baby developed tooth buds, the foundation for baby teeth (also called milk teeth). Only one in 2,000 babies is born with teeth, though. The vast majority sprout their first tooth between 4 and 7 months of age. If your baby is an early developer, you may see his first white cap (usually the lower central incisor) as early as 3 months. If he's a late bloomer you may have to wait until he's almost a year old. The last teeth (the second molars, found in the upper and lower back of the mouth) usually come into place by the second year. By age 3, your child should have a full set of 20 baby teeth.



How it develops

The arrival of the first tooth can be a long, drawn-out process. You may notice your baby drooling heavily a month or two before you see a tooth. You may also notice that your baby's cheeks appear slightly fuller; that's because his gums are a little swollen. Although it's commonly believed that teething causes pain, colds, diarrhea, and fever, research strongly suggests that there is no real association between these symptoms and teething. Still, if you think your baby hurts, give him something to bite or rub his gums on. (And keep in mind that if he starts biting now, it's not out of anger or hostility.) While many babies seem to struggle, others get through teething with little pain or discomfort. One week your babe is sporting a toothless grin, and the next a jagged white edge appears on the gum surface. Celebrate the first tooth by taking lots of pictures, and note its arrival date in his baby book. Teeth sprout one after another, and often — but not always — in this order: first the bottom front ones, then the top two middle ones, then the ones along the sides and back. Tooth development is hereditary, so if you or your partner got your teeth early, chances are your child will, too.



What's next

Baby teeth won't fall out until your child's permanent teeth are ready to come in, sometime around age 6.

Your role

You can't do anything to make teeth appear, but you can comfort your baby if you think the process troubles him. Give him something to chew on, such as a teething ring kept in the refrigerator. He may also get some relief from eating cold foods such as applesauce or yogurt. Some pediatricians recommend giving a teething baby a small dose of children's pain reliever such as infant's acetaminophen, but check with the doctor before giving your baby any medication. If your child is running a temperature, call your doctor — he may have an ear infection or other illness. Once your baby's teeth are in, it's up to you to keep them clean. For the first year, you won't really need to brush them, but do try to clean his teeth and gums at least once a day, perhaps as part of his bedtime routine, by wiping them with gauze or a face cloth. And never put your baby to bed with a bottle. Formula and breast milk can pool in his mouth at night and lead to a condition known as baby-bottle tooth decay. It's also a good idea to wean your baby off the bottle by his first birthday, to reduce the chances of cavities. The 6-month well-baby checkup is a good time to ask your child's doctor whether your baby needs fluoride (these cavity-fighting drops are necessary only if you live in an area where the water supply isn't fluoridated). You should also ask the doctor to examine your child's teeth. At about 18 months, your child may be ready to learn to brush his teeth. You'll have to help, since he won't have the dexterity or the concentration to maneuver a toothbrush. Use a soft brush and — if you like — a small dollop (about the size of a pea) of non-fluoridated toothpaste. (The American Academy of Pediatric Dentistry recommends waiting to use fluoridated toothpaste until your child is 2 to 3 years old, and then using only a pea-sized amount.) You don't have to brush in a certain direction; just try to get any food particles out. If your child doesn't like the taste of the toothpaste, try another brand or skip it entirely. You don't really need to use toothpaste unless your child's diet includes lots of sugary foods — which you should avoid anyway. If he does indulge in sweets (at a birthday party for example), make sure to brush his teeth soon after he eats. Schedule a checkup with a pediatric dentist for around your child's first birthday.

When to be concerned

If by the end of the first year you still don't see any sign of a tooth appearing, bring the matter up at your child's 12-month checkup. (Premature babies may be a few months behind in getting their teeth.) If your child has all the signs of teething — heavy drooling, swollen gums — but also seems to be having unusual pain (crying inconsolably is a big clue), call his doctor. Teething shouldn't be an excruciating ordeal for a baby.