As a Sleep Coach, there are many questions that I am asked quite frequently. How to approach sleep when baby is teething is definitely at the top of that list. If you’ve read my bio, you’ll know that as first-time parents we struggled majorly in the sleep department for the first few months. We climbed out of that sleep deprivation hole only for someone to casually say to me, ‘Wait until she starts teething’. WHAT!? NO! In my head, with every tooth that came in, we’d be back at square one with all-night wakings, zero naps, and a screaming, overtired baby. Luckily – this doesn’t need to be the case. Read on below to find out why teething can affect sleep and what to do to help ensure sleep doesn’t majorly regress during this inevitable time.

How can teething affect sleep?

Teething gets a really bad rep for creating a host of sleep issues and it can - especially for a child that already struggles to connect sleep cycles [sleep training for the win!]

Teething won't necessarily CAUSE your baby to wake through the night but for a baby that's already wakeful, it can make re-settling very difficult. It can also make the initiation of sleep more challenging as well if baby is experiencing discomfort.

There are 2 different types of teething - chronic teething [which is basically happening all the time as the teeth are slowly moving their way up through the gums and is on and off for the first 2+ years of a child’s life] and acute teething. Teething is at its worst [acute teething] when you can see those little white bumps just before they pass through the sensitive nerve endings near the skin surface. Once the tooth is through, the discomfort is mostly gone. This should take no longer than 3 days to occur so if your sleep is out of whack for weeks - teething isn't likely to blame. 

It can be difficult to know with certainty whether wakings at night are teething related or not. One good way of determining this is whether your baby’s wakings are occurring in a pattern or not. So, for example, if your baby is waking up at the end of every single sleep cycle [60-90 minutes at the beginning of the night, every 2-3 hours as the night goes on] then teething isn’t likely to blame, and it’s more likely a habit/sleep association/schedule issue. If your baby starts waking up at random times [say, at 9:00pm when they usually sleep until at least 1:00am, or every hour in the second half of the night] then teething might be to blame.

What are some other tell-tale signs that your baby might be teething?

• Baby seems uncomfortable or extra fussy during the day

• Gums are red, swollen, or bulging

• You can see a little white nub right below the surface of the gums

What are not typically signs of teething?

• Drooling

• Hands in mouth

• Fever [a slightly elevated body temperature [think: 99-99.5°] can be normal but an actual fever is not an indication of teething and if your baby has a fever and is sleeping poorly, you may want to rule out an ear infection]

• Diarrhea

• Cough

• Congestion

• Vomiting

What can we do to help when baby is teething?

The best weapon against teething discomfort preventing a good night’s sleep is a dose of Tylenol/Motrin before bed. If your baby is 6+ months of age, then I would be giving Motrin vs. Tylenol as it is an anti-inflammatory as well as a fever and pain reliever. Give the Motrin 30 minutes before bed if you suspect teething pain/discomfort. If your baby has been waking in the middle of the night or early morning and struggling to fall back asleep/stay asleep, then go in at the 6 hour mark and re-dose baby to help them through the second half of the night [this is like a dreamfeed but with medicine, let’s call it a ‘dream dose’!. While your baby is still asleep gently put the syringe of pain reliever into the back corner of their mouth. Very gradually squeeze the medicine into their mouth. Most babies will just swallow the medicine without waking up. If the on-set of sleep or early part of the night is when baby is struggling, there’s no need to offer the dream dose unless they wake in the middle of the night and are having a tough time re-settling.  If your baby still wakes up for nightfeeds, you can preemptively re-dose them at one of their feeds just to help avoid any issues through the second half of the night.

**speak to your healthcare provider before offering any medication, this is not medical advice

If your baby wakes in the middle of the night and is needing comfort and that 2nd dose of medicine and you haven’t done the ‘dream dose’, consider holding them for 30 minutes until the medicine takes effect, and this should help you to be able to lay them down afterwards.

Keeping a consistent routine and schedule when your baby is teething is important as well! Continue to lay them down awake, continue to always give them time to re-settle on their own in the middle of the night if they do wake, continue to be consistent in how you respond to any protesting/middle of the night wakeups, and try to avoid bringing in any long-term habits for a short-term phase. It’s important to especially try to avoid bringing back the associations that you worked the hardest at undoing [i.e. if you were previously bedsharing and have now moved baby to his own bed, try to avoid bringing baby back into your bed and perhaps try to comfort by rocking instead. Or, if you have worked hard to eliminate a nursing association, try to avoid using nursing as a comfort tool if possible].  In saying this, if all else fails and your baby is really struggling, you can do what you need to do to help, but just remember the key is getting back on track the DAY baby is better.

So, put together, what might your teething plan of attack look like?

You notice baby is acting extra fussy today. You look inside baby’s mouth and there is a super swollen gum with a tiny white bump right under the surface with a small section poking through. In hopes of avoiding a tough night, you give baby a dose of Motrin before her bath, about 30 minutes before bed. Baby falls asleep well but then wakes up at 2:00am crying [this is an abnormal time for her to be waking up]. You wait 10 minutes to see if she can re-settle on her own without help, but then you go in and pick her up to comfort her. Seeing as it’s been 6+ hours since her last dose of Motrin, you re-dose her and hold her in the rocking chair for half an hour. After 30 minutes you lay her back down - but she starts to cry again. You leave the room to see if she can re-settle but after 10 minutes she’s still crying. Knowing she might be in discomfort, you go back in the room and hold her again, hoping to get her sleepy enough to lay her back down and have her stay asleep [I would repeat this in 10 minute intervals as needed]. The next transfer is successful, and she stays asleep the rest of the night.  The next night, you offer a dose of Motrin 30 minutes before bed but then also do a ‘dream dose’ at 1:00am [6 hours after 1st dose] to try and avoid the middle of the night waking – and it’s a success! To be careful you do this for one more night [3 nights total of possible teething discomfort].

Pam Edwards is a Certified Infant & Child Sleep Consultant and founder of Wee Bee Dreaming Pediatric Sleep Consulting, now based out of Kamloops, B.C. Healthy sleep is addicting and she has made it her life mission to help families all across the world get the sleep they deserve - a good night's sleep doesn't have to be a dream!