Do babies develop fever when teething?

Teething Does Not Cause Fever in Babies

Teething does not cause significant fever (≥38°C/100.4°F) in babies, and any fever during teething should be considered unrelated and potentially indicative of another condition requiring medical evaluation. 1, 2

Understanding Teething and Fever

What the Evidence Shows:

• Teething may be associated with a mild temperature elevation but not with true fever (≥38°C/100.4°F) 1
• In a large prospective study of 125 children with 475 tooth eruptions, fever over 102°F (38.9°C) was not significantly associated with teething 1
• When babies present with fever, attributing it to teething can be dangerous as it may lead to missing serious underlying conditions 3, 4
• In one study, out of 50 babies hospitalized for symptoms attributed to teething, 48 had an organic cause of illness 4

Symptoms Actually Associated with Teething:

• Increased biting and gum-rubbing
• Drooling
• Irritability
• Mild wakefulness
• Ear-rubbing
• Facial rash
• Decreased appetite for solid foods
• Mild temperature elevation (but not true fever) 1

Clinical Approach to Febrile Infants

When a Baby Has Fever:

• Fever in pediatric patients is defined as a rectal temperature greater than 38°C (>100.4°F) 5
• Fever in infants requires evaluation for potential serious bacterial infections:
  • Urinary tract infections are common in febrile infants (3-7% prevalence in children 2 months to 2 years with no identifiable source) 6
  • Neonates and young infants have higher risk of serious bacterial infections 6, 5

Risk Assessment for Febrile Infants:

• Infants <28 days with fever require complete sepsis evaluation 5
• Children 29-90 days require evaluation based on risk factors 5
• The absence of another source of infection increases the risk of urinary tract infection 6

Common Pitfalls to Avoid

1. Misattribution Error: Never attribute fever to teething without ruling out other causes 4, 2
2. Delayed Diagnosis: Assuming fever is from teething can delay diagnosis of serious infections 3
3. Symptom Confusion: While teething may cause irritability and disturbed sleep, these symptoms should not be confused with those of actual illness 1
4. Overtreatment: Treating for teething when a child has fever may lead to inappropriate management 2

Key Takeaway

When evaluating a febrile infant, clinicians should perform a thorough assessment for potential sources of infection rather than attributing the fever to teething. Symptoms like diarrhea, respiratory symptoms, fever, or convulsions should not be attributed to teething and require proper medical evaluation 4, 2.