Teething or Illness? How to Tell the Difference

When your baby is dribbling, chewing everything and suddenly more unsettled, teething can seem like the obvious explanation. Sometimes it is. But babies can also become ill while they are teething, and not every fever, upset tummy or difficult night should be blamed on new teeth.

The NHS lists sore red gums, increased dribbling, chewing, one flushed cheek, a facial rash, ear rubbing, fretfulness and poorer sleep among possible teething symptoms. A baby’s temperature may be slightly raised during teething, but it should remain below 38°C. The NHS also says there is no evidence that teething causes diarrhoea.

A useful rule is to look at your whole baby rather than one symptom. Mild gum discomfort in a baby who is otherwise alert and behaving normally is different from a baby who seems genuinely unwell, has a high temperature, is struggling to breathe, is difficult to wake or is feeding much less than usual.

What are normal teething symptoms?

Babies experience teething differently. Some teeth appear with little or no noticeable discomfort, while others seem to cause a few difficult days.

According to the NHS, possible teething symptoms include:

A sore, red gum where the tooth is coming through
A slightly raised temperature below 38°C
One flushed cheek
A facial rash
Ear rubbing
More dribbling than usual
Increased chewing and gnawing
Greater fretfulness
Poorer sleep

You may notice several signs at once, or only one or two.

Seeing a tooth beginning to emerge alongside these symptoms can make teething a more likely explanation, but you still do not need to attribute every new symptom to it.

What symptoms are less likely to be teething?

A high temperature of 38°C or above should not simply be labelled as teething.

The NHS defines 38°C or more as a high temperature in babies and children, while its teething guidance says a teething-related temperature may be slightly raised but remains below 38°C.

The NHS also says there is no evidence that teething causes diarrhoea.

Other symptoms that deserve more attention include:

Repeated vomiting
Significant diarrhoea
Difficulty breathing
A baby who is unusually sleepy or difficult to wake
Feeding much less than usual
Signs of dehydration
A concerning or non-fading rash
A baby who does not respond or behave as they normally do

These symptoms have many possible causes. The important point is not to explain them away as teething.

Teething or fever?

This is one of the most important distinctions for parents.

A slightly raised temperature below 38°C can occur during teething, according to the NHS.

A temperature of 38°C or higher is a fever.

If your baby feels hot, use a digital thermometer to check rather than relying only on touch.

Age matters too. NHS guidance says you should call NHS 111 or your GP surgery if a baby under 3 months has a temperature of 38°C or higher. For babies aged 3 to 6 months, a temperature of 39°C or higher also needs urgent advice.

A fever can happen while a baby is teething, but that does not mean the tooth caused it.

Teething or diarrhoea?

Loose stools are often blamed on teething, but the NHS says there is no evidence that teething causes diarrhoea.

If your baby develops diarrhoea, consider it separately from their teething symptoms.

Watch for signs of dehydration, particularly if diarrhoea is frequent or accompanied by vomiting.

The NHS lists fewer wet nappies, few or no tears when crying and a sunken soft spot on a baby’s head among possible signs of dehydration.

If your baby is showing signs of dehydration or you are worried, seek medical advice.

Teething or an ear infection?

Ear rubbing is included on the NHS list of possible teething symptoms, which can make this one confusing.

Babies may rub an ear while teething, but ear discomfort can also have other causes, including an ear infection.

Look at what else is happening.

If your baby is rubbing an ear but otherwise seems well and has other obvious teething signs, it may be connected with teething.

If they seem unwell, have a high temperature, are in significant pain or you are concerned about their symptoms, contact a GP or NHS 111.

You do not need to determine the cause yourself before asking for advice.

Teething or a cold?

Dribbling can make a teething baby seem rather wet around the mouth, but a runny nose, cough and other respiratory symptoms are not on the NHS list of typical teething symptoms.

Babies and young children commonly pick up respiratory infections, so a cold can easily arrive at the same time as a new tooth.

Pay particular attention to breathing.

If your child has difficulty breathing, is breathing very fast, is grunting or their tummy is sucking in under the ribs, NHS guidance says this needs emergency assessment.

Do not assume breathing changes are caused by teething.

Teething or a rash?

The NHS includes a facial rash among possible teething symptoms.

Increased dribbling may leave the skin around the mouth and chin irritated, especially if it remains damp.

However, babies can develop many different rashes.

A widespread rash, a rash accompanied by a high temperature or a baby who seems unwell should not automatically be described as a teething rash.

A rash that looks like bruising or bleeding under the skin and does not fade when pressed with a glass is an emergency sign in an unwell child. NHS guidance says to call 999 or go to A&E.

If you are simply unsure what a rash is, NHS 111 or your GP can advise.

Teething or poor sleep?

Poorer sleep is listed by the NHS as a possible teething symptom.

Sore gums can make some babies more unsettled than usual, particularly for a few days around a tooth emerging.

But sleep can change for many reasons.

Hunger, changes in routine, developmental changes, temperature, illness and discomfort can all affect how a baby settles.

If poor sleep is the only symptom and your baby seems well during the day, there may be no reason to assume illness.

If sleep changes happen alongside fever, breathing difficulties, unusual drowsiness, poor feeding or other concerning symptoms, look beyond teething.

Teething or reduced appetite?

A baby with sore gums may seem less enthusiastic about eating for a short time, but significant changes in feeding deserve attention.

The NHS advises seeking urgent medical advice for several childhood illnesses if a baby is feeding or eating much less than normal.

For young babies in particular, feeding is an important part of assessing how well they are.

If your baby repeatedly refuses feeds, is taking much less than usual or has fewer wet nappies, contact a healthcare professional.

Do not assume poor feeding is simply because a tooth is coming through.

Look for signs of dehydration

Illness involving fever, vomiting, diarrhoea or reduced feeding can increase the risk of dehydration.

According to the NHS, possible signs include:

Fewer wet nappies
Few or no tears when crying
A sunken soft spot on the head
Unusual sleepiness
Fast breathing

If you think your baby is dehydrated, get medical advice.

A baby who is difficult to wake, has breathing difficulties or has blue, grey, pale or blotchy skin alongside signs of dehydration needs emergency help.

Your baby’s behaviour matters

A temperature or rash is useful information, but behaviour matters too.

You know what is normal for your baby.

A teething baby may be grumpy and clingy but still have periods where they are alert, interested in you and reasonably themselves.

A baby who is unusually floppy, difficult to wake, confused, not responding normally or extremely distressed needs more urgent attention.

NHS guidance specifically includes changes in responsiveness and unusual drowsiness among warning signs of serious illness.

If your baby’s behaviour worries you, seek help even if you cannot identify a specific symptom.

Can babies be teething and ill at the same time?

Yes.

Teething happens over a long period of infancy and toddlerhood. During that time, babies will also experience ordinary infections and illnesses.

A visible tooth does not rule out another problem.

Your baby might genuinely have sore gums while also developing a cold, stomach bug, ear infection or another illness.

This is why it is useful to separate familiar teething signs from symptoms that are not usually explained by teething.

What should you do if it seems like teething?

If your baby appears otherwise well and has mild, familiar teething symptoms, simple comfort measures may help.

The NHS recommends options such as a suitable teething ring and gently rubbing the gums with a clean finger.

Some teething rings can be chilled in the fridge according to their instructions, but they should not be frozen because this can damage the gums.

If your baby seems to be in pain, appropriate children’s pain relief may sometimes be considered, but suitability depends on age, weight, the exact medicine and your child’s health.

Always follow the instructions for the medicine you have and ask a pharmacist or healthcare professional if you are unsure.

Avoid using medicine to decide whether it is teething

If pain relief seems to make your baby more comfortable, that does not prove teething was the cause.

Pain-relieving medicines can reduce discomfort from many conditions.

Similarly, a temperature coming down after medicine does not establish why the fever occurred.

Continue to watch your baby’s overall condition and seek advice if they seem unwell.

Keep track of symptoms

When you are tired, it can be difficult to remember exactly when something started.

If you are uncertain whether your baby is teething or becoming ill, make a quick note of:

Their temperature
How well they are feeding
Wet nappies
Vomiting or diarrhoea
Any rash
Changes in breathing
How alert and responsive they are
When symptoms started

This information can also be useful if you need to speak to NHS 111, a pharmacist or your GP.

You do not need to monitor every tiny change. Focus on the symptoms that help show whether your baby is otherwise well.

When to get professional advice

Contact your GP or NHS 111 if you are unsure whether your baby’s symptoms are caused by teething, particularly if they seem unwell or their symptoms are getting worse.

NHS guidance says to seek urgent advice if a baby under 3 months has a temperature of 38°C or higher, or if a baby aged 3 to 6 months has a temperature of 39°C or higher. A high temperature accompanied by a rash, signs of dehydration, poor feeding or a child who is not their usual self also needs medical advice.

Call 999 or go to A&E if your baby has serious warning signs such as difficulty breathing, blue, grey, pale or blotchy skin, is difficult to wake, is not responding normally, has a first seizure, has a stiff neck or has a rash that does not fade when pressed with a glass.

If you are worried even when your baby’s symptoms do not fit neatly into a list, ask for help. Teething is common, but it should not be used to dismiss signs that your baby may be ill.