Teething

Cutting teeth is not 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 little one three years to complete. Whenever the first tooth peeks through, celebrate it by taking pictures and noting its arrival date in your child's baby book.

By the time your little one is three, he will 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 is at least six years old.) By age three, your child should have a full set of 20 baby teeth.

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 four- and seven-months of age.

If your baby's an early developer, you may see his first white cap (usually one of the bottom middle teeth) as early as three months. If he is a late bloomer you may have to wait until he is a year old or more. The last teeth to appear (the second molars, found in the very back of the mouth on the top and bottom) have usually begun coming into place by your baby's second birthday. By age three, your child should have a full set of 20 baby teeth.

How it develops

While some babies breeze through the teething process, many seem to struggle with it and experience discomfort. Among the symptoms your teething baby may exhibit:

Drooling (which can lead to a facial rash)
Gum swelling and sensitivity
Irritability or fussiness

Biting behavior
Refusing food
Sleep problems

There is a debate among experts over whether certain problems - like diarrhea, fever, congestion, body rashes, and vomiting - can be caused by teething. A rule of thumb: If your baby has symptoms that worry you, don't just chalk it up to teething. Check with your doctor to rule out other potential causes that may need attention.

What to do?

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 or a wet washcloth cooled in the refrigerator. He may also get some relief from eating cold foods, like applesauce or yogurt. Giving him a hard, unsweetened teething cracker such as zwieback to gnaw on is another time-honored trick. Massaging his gums is another way to soothe his discomfort - after washing your hands, rub his gums gently but firmly with your finger. The pressure provides a welcome balance to the pressure your baby feels coming from the buried teeth below.

If none of this helps, your doctor may suggest giving your baby a small dose of children's pain reliever such as infants' acetaminophen to ease the pain and inflammation. Rubbing the gums with a topical pain relief gel is also an option, but you may want to ask the doctor before trying it. If you use too much, it can numb the back of your baby's throat and weaken his gag reflex (which helps keep him from choking on his saliva). The gels are generally safe to use, but in rare cases can cause an allergic reaction.

If drool causes a rash on your baby's face, wipe, but do not rub, the drool away with a soft cotton cloth. You can also smooth petroleum jelly on his chin before a nap or bedtime to protect the skin from further irritation. .

Once your baby's teeth are in, it is up to you to keep them clean. For the first year, you won't really need to brush them, but you should clean his teeth and gums at least twice a day by wiping them with gauze or a wet washcloth.

Never put your baby to bed with a bottle (unless the bottle is filled with water). That is because the sugars in formula and breast milk will sit on his teeth all night and can lead to a condition known as baby-bottle tooth decay, or bottle rot. Another way to avoid this condition and reduce the risk of cavities is to transition your baby from a bottle to a cup by sometime around his first birthday, when he is coordinated enough to manage it. When your child drinks out of a sippy cup, he is more likely to finish his drink in a short time - and avoid the prolonged exposure to sugars that comes with sipping from a bottle all day long.

The six-month well-baby check-up is a good time to ask your child's doctor whether your baby needs fluoride (these cavity-fighting drops are necessary only if the water supply in your area is not fluoridated). You should also ask the doctor to examine your child's teeth. Your baby's first dentist visit should happen around the time he turns one-year. If he hasn't sprouted his first tooth by then, talk to your doctor, who can let you know whether or not a visit to the dentist is necessary.

Teeth and Crying

The fact that a baby is in the process of cutting a tooth is too often used to explain fretful or irritable behavior or even illness. A baby who cries a lot and is difficult to keep cheerful is very hard to bear, as we have seen. Deciding there's a physical cause of crying may make it easier to stay patient with the baby, but at this age putting it down to teething is neither accurate nor safe.

Teething seldom causes trouble in babies under four months.

Since the first tooth will not be cut until five to six months, irritability in a three-month-old baby is most unlikely to be due to that future event.

When a tooth is nearly due it is still most unlikely to cause anything more notable than a slightly inflamed gum, a bit of dribbling and a lot of chewing. The first teeth are cut very easily. It is the first molars, cut around a year, which can announce their arrival with real pain.

Believing that your baby's behavior is due to teething may lead you to neglect real illness.

A few babies each year reach the hospital in a serious condition because parents assumed that signs which were really symptoms of illness were only due to teething and therefore did not call their doctor in time.

Teething cannot cause fever, diarrhea, vomiting, loss of appetite, convulsions or "fits."

So if your baby seems ill, consult your doctor irrespective of the state of his coming teeth. If the baby seems well, all you need to do is wipe the dribble off his chin so that the continual wetness does not make it sore and give hard zweibacks or teething rings if he seems to want to bite a lot.

Try to avoid using teething gels on the baby's gums.

Most of them contain quite powerful drugs. Just rubbing the gums with your finger will probably help just as much. If your baby seems really uncomfortable, try something cold to bite on may be comforting.

Babies cut their teeth in a particular order and roughly at certain ages. But there is a wide variation in those average ages. A baby who cuts teeth earlier than average is not brighter or more forward than the baby who cuts them later. The actual age at which they appear has no importance - except that once your baby has a tooth you will never again see that particular toothless grin!

Teeth and Chewing

First teeth are not chewing teeth, they are biting-off teeth. A baby cuts the front teeth first, and does not chew with those any more than an adult does.

Babies start chewing with their gums and perfect the technique long before they acquire teeth at the back of the mouth to help them. So don't assume that a baby with one solitary front tooth cannot chew. He can and must.

Babies start teaching themselves to chew as soon as they can get their hands and the toys that they hold into their mouths. It is important that they should be given foods to chew soon after this, and certainly before six months.

Babies who are fed entirely on semi-liquid foods until they have some chewing teeth at around a year often refuse to chew food at all. They have gotten so used to slops that really solid food revolts them and makes them gag. If your baby is given hard foods to suck at the four-to-five-month stage when objects are being explored by mouthing, he will take much more easily to family meals later on. Chewing hard foods is good for the baby's developing jaw, too. It makes it less likely that orthodontic treatment (braces and so forth) will be needed later on. Feeding themselves, with their own hands, long before they can feed themselves with a spoon, also gives babies a good start toward feeling enthusiastic and independent about eating. So as soon as toys go in your baby's mouth, give him hard foods to put in too. Peeled pieces of apple are good; so are hard baked crusts, sugar-free zwieback or raw scrubbed carrots.

But your baby should never have any of these things when lying down - he might choke or poke an eye with the carrot. And once babies cut a tooth or two you need to be extra watchful even when they have these foods while sitting in their chairs. New teeth are sharp. Your baby might grate a tiny piece off that apple and choke on it. If you are there, a quick pat between the shoulder blades will help him cough it out of the windpipe.

Teeth and Weaning

Your baby's first tooth will be visible as a small, pale bump under the gum for days before it emerges. When its point breaks through, it will be sharp. You may be tempted to regard it as a signal to speed up weaning. But there is no need to worry about the possibility of the baby biting your nipple. This first tooth, and the second one which will follow it two or three weeks later, is a bottom tooth. The baby has no matching top tooth against which to pincer anything. It will be months yet before he can bite you.

First Teeth

After months of toothless grins, your baby's teeth will begin to emerge. The first one, cut somewhere near the six-month birthday, will be a bottom front tooth, and the one next to it will follow. Early teething does not mean that your baby is advanced, nor does late teething mean that he is backward. Babies reveal their teeth in a particular order, but at widely varying ages.

Most babies get new teeth in this order: first the bottom two middle ones, then the top two middle ones, then the ones along the sides and back.

[picture]