Teething or regression? How to tell
You have been blaming teeth for six weeks. Teeth are real, and they are also the most over-used explanation in the first two years - mostly because there is always a tooth on the way.
3 min read
A baby gets around twenty teeth between roughly six months and two and a half years. At any given moment one is plausibly coming. That makes teething an explanation that can never be ruled out, and therefore one that explains nothing very usefully.
The distinguishing feature is duration. Discomfort around an individual tooth lasts a few days. Sleep disruption that has run for weeks has a different cause, and continuing to attribute it to teeth means whatever is actually happening goes unaddressed.
What teething looks like
Two to five days, not weeks. Worst in the day or two before the tooth breaks through, then it stops.
Visible signs. A swollen or reddened gum, a white point under it, one flushed cheek, heavy drooling, chewing on everything.
Worse lying down. Fine during the day and difficult at night is characteristic.
A tooth actually appears. The retrospective confirmation. If no tooth has arrived in a fortnight, it probably was not teeth.
What it is if it has run for weeks
A developmental leap - a new motor skill, a language burst, separation anxiety - which typically runs two to six weeks and comes with something new you can name. Or a schedule that no longer fits: wake windows lengthen, and a bedtime that was right a month ago can be twenty minutes wrong now.
Or something medical. Ear infections, reflux, constipation and sleep-disordered breathing all produce persistent night waking and are all routinely attributed to teeth for months before anyone checks.
There is always a tooth coming. That is precisely why it explains so little.
How to work it out
Write down the nights for a week. Teething disruption is spiky - two or three bad nights, then normal ones. A leap or a schedule problem is consistent. That pattern alone usually settles it.
And look in their mouth. A gum with a tooth pushing through looks obviously different from one without, and it takes ten seconds.
What to do while you work it out
You do not have to know the cause to respond sensibly. Whether it is teeth or a leap, the same things apply: keep the schedule steady, bring bedtime forward, give more comfort in the moment, and do not introduce anything you would not want to keep.
The one decision that does depend on the answer is pain relief, and that is worth getting right. Paracetamol on a night when it is genuinely teeth is reasonable and helps. The same medicine every night for three weeks is not treating teething; it is medicating something undiagnosed, and it is worth a GP appointment instead.
Why the label matters
Attributing everything to teeth is the most common way a genuine problem goes unnoticed in the first two years. Ear infections, reflux, constipation and sleep-disordered breathing all produce night waking, and all of them get filed under teething for weeks at a time because there is always a tooth on the way.
It also delays the useful work. A fortnight blamed on teeth is a fortnight not spent checking wake windows, which is the single most common non-medical cause of a sudden run of bad nights. Neither costs much to rule out, and both are worth ruling out before settling on the explanation that requires no action.
When to stop troubleshooting
Fever, diarrhoea, vomiting, a rash, ear-pulling, refusing feeds or poor weight gain are never teething. See your GP. So is any disruption lasting more than six weeks without an identifiable cause, particularly alongside snoring or noisy breathing.
Want this worked out for your baby instead?
The quiz takes three minutes and asks about your nights, not just their age.
Take the 3-min quiz →General guidance, not medical advice. Your paediatrician's advice takes precedence.
