Baby Sleep Regressions vs. Teething: How to Tell the Difference (5 Clear Signs)

The Quick Answer: Here’s How to Tell the Difference

Teething causes SHORT sleep disruptions (24-72 hours of peak discomfort) with visible physical signs like swollen gums, excessive drooling, and daytime fussiness. Your baby will show symptoms throughout the day, not just at bedtime.

Sleep regressions last LONGER (1-6 weeks), happen at predictable ages (4, 8, 12, 18 months), show NO physical symptoms, and coincide with developmental milestones like rolling, crawling, or walking.

Why this matters: If you treat a sleep regression like teething (offering pain relief and extra comfort), you might create new sleep associations that last long after the regression passes. If you ignore teething pain thinking it’s “just a phase,” your baby suffers unnecessarily.

The 5 Key Differences at a Glance

Here’s your quick reference guide to tell teething apart from sleep regressions:

Quick Takeaway: If your baby has been struggling for more than a week with no visible tooth, you’re likely dealing with a sleep regression—not teething.

What Is Teething? (And What It Does to Sleep)

When Do Babies Start Teething?

Most babies get their first tooth between 4-7 months old, but teething can start as early as 3 months. According to the American Academy of Pediatrics, babies are born with all 20 primary teeth already in their jaws—they just need to push through the gums.

The first teeth to appear are usually the lower central incisors (bottom front teeth), followed by the upper central incisors. By age 3, your child will have a complete set of 20 baby teeth.

Real Teething Symptoms (According to Research)

Not everything parents blame on teething is actually caused by teething. A 2011 study published inPediatrics followed 47 infants daily through their teething journey. Here’s what researchers found were the actual symptoms associated with tooth eruption:

TRUE Teething Symptoms:

• Irritability (most common—your baby is just uncomfortable!)
• Increased drooling (you’ll see clearer spit than usual)
• Gum rubbing and biting (constant chewing on toys, fingers, everything)
• Slight temperature increase (up to 99.5°F—NOT a true fever)
• Loss of appetite (especially for solid foods)
• Sleep disturbance (waking more frequently for 2-3 days)

NOT Caused by Teething:

• Fever over 100.4°F (this means infection, not teething)
• Runny nose (mild, clear discharge)
• Severe diarrhea or vomiting (call your doctor)
• Excessive crying that can’t be soothed (look for other causes)
• Diaper rash (unrelated to teething)

 🌙Pain is WORSE at night When your baby lies down, blood flow increases to the head, which intensifies gum pressure and pain. This is why your teething baby might nap okay during the day but wake screaming at 2 AM.

⏱️ SHORT duration The 24-72 hours before a tooth breaks through are the worst. Once that tooth erupts, sleep typically returns to normal within days.

😴 Frequent wake-ups Teething babies often wake every 30-50 minutes during a sleep cycle because the pain jolts them awake during light sleep phases.

Example: Your 6-month-old has been sleeping 8-hour stretches. Suddenly, she’s waking every hour, drooling heavily, and gnawing on everything. You feel a hard bump on her lower gum. That’s teething—and once that tooth breaks through in 2-3 days, sleep should bounce back.

What Is a Sleep Regression? (And Why It Happens)

Common Sleep Regression Ages

Sleep regressions aren’t random—they happen at predictable developmental stages:

What Causes Sleep Regressions

Sleep regressions happen because your baby’s brain is leveling up. Here’s what’s going on:

🧠 Brain Development
At 4 months, your baby’s sleep architecture permanently changes from newborn sleep to adult-like sleep cycles. This isn’t a regression—it’s an evolution. But it means your baby now has brief awakenings between sleep cycles and needs to learn how to fall back asleep independently.

🤸 Physical Milestones
Rolling, sitting, crawling, standing, walking—each new skill is SO exciting that your baby wants to practice it at 2 AM instead of sleeping.

💔 Separation Anxiety
Around 8-10 months, babies develop object permanence (understanding that things exist even when they can’t see them). Suddenly, your baby realizes you’ve left the room—and panics. This is a normal cognitive leap documented by the American Academy of Pediatrics.

How to Tell the Difference: 5 Diagnostic Clues

Let’s get practical. Here are the exact steps to figure out what you’re dealing with:

Clue #1 – Check Your Calendar (Age & Timing)

Teething: Can happen anytime from 3-36 months. Sporadic and unpredictable.

Regression: Clusters around 4, 8, 12, and 18 months.

🚩 Red Flag: If your baby is exactly 4 months old OR just turned 8 months AND has no visible gum swelling → likely regression.

Clue #2 – Look at the Duration

Teething: Intense for 2-3 days, resolves within a week once tooth erupts.

Regression: Lasts 1-6 weeks even with a consistent approach.

🚩Red Flag: If sleep issues persist beyond 2 weeks with no tooth appearing → likely regression (or illness—call your pediatrician).

Clue #3 – Examine the Gums and Behavior

Teething:

• 🦷 Swollen, red gums with visible white nub
• 🦷 Excessive drooling (soaking through shirts)
• 🦷 Biting EVERYTHING (toys, fingers, furniture)
• 🦷 Fussy ALL DAY, not just at bedtime

Regression:

• 😴 No physical symptoms whatsoever
• 😴 Happy and active during the day
• 😴 Only struggles at nap times and bedtime

Action Step: Gently rub your baby’s gums with a clean finger. If they lean into the pressure and seem soothed, it’s likely teething. If they push you away or don’t care, probably not teething.

Clue #4 – Watch the Clock

Teething: Pain is WORSE at night. Lying down increases blood flow to the head, intensifying gum pressure. Your baby might nap somewhat okay during the day but have terrible nights.

Regression: Struggles with BOTH naps and bedtime equally. No time-of-day pattern.

Clue #5 – Note New Skills

Teething: No new developmental milestone happening.

Regression: Recently started rolling, sitting, crawling, pulling to stand, walking, or talking.

Real Example: “Your 8-month-old just learned to pull to stand. Now she’s standing in her crib at 2 AM, crying because she’s stuck and doesn’t know how to sit back down. She practices standing ALL NIGHT instead of sleeping.”

That’s a regression, not teething.

Take the Quick Diagnostic Quiz

What to Do About Teething Sleep Disruptions

Now that you know it’s teething, here’s how to help your baby (and yourself) get through it:

Immediate Relief Strategies

🤲 Gum Massage
Wash your hands, dip your finger in cool water, and gently massage the swollen area before bedtime. Many babies find counter-pressure soothing. Let your baby gnaw on your finger—it’s actually comforting!

🧊 Cold Teethers
Chill (don’t freeze solid) rubber or silicone teethers. The cold numbs gums temporarily. Avoid liquid-filled teethers that can break and leak.

💊 Pain Relief (With Doctor Approval)
For babies 6+ months, consult your pediatrician about infant acetaminophen (Tylenol) or ibuprofen (Motrin/Advil) before bedtime. A 2024 FDA update confirms these are safe when used as directed.

What NOT to Do (FDA Warnings)

❌ Benzocaine Gels (Orajel, Anbesol)
The FDA warns that these numbing gels can cause methemoglobinemia, a rare but potentially fatal blood disorder. Excess drool washes them away quickly anyway, so they’re both dangerous AND ineffective.

❌ Lidocaine Products
Prescription numbing medications have been linked to heart problems, seizures, and brain injury in infants. Never use these without explicit doctor supervision.

❌ Amber Teething Necklaces
These pose serious choking and strangulation risks. The American Academy of Pediatrics strongly advises against them.

What to Do About Sleep Regressions

Sleep regressions require a different approach than teething because the issue isn’t pain—it’s development.

The 4-Month Regression (Special Case)

This one deserves special attention because it’s permanent. Your baby’s sleep cycles have matured from newborn to adult-like patterns. You can’t “wait it out”—you need to adapt.

What to do:

1. Lengthen wake windows to 90-120 minutes (up from 45-60 minutes at 3 months)
2. Create a consistent bedtime routine (feed, bath, book, bed—same order nightly)
3. Put baby down drowsy but awake so they learn to self-soothe
4. Be patient—this adjustment takes 2-6 weeks

General Sleep Regression Strategies

1. Adjust the Schedule – Wake windows need to increase as babies age
2. Practice New Skills During the Day – Make milestones boring, not exciting
3. Address Separation Anxiety – Peek-a-boo games, consistent goodbyes
4. Maintain Consistency – Don’t abandon your sleep routine
5. Move Bedtime Earlier If Needed – Compensate for missed nap sleep
6. Wait It Out With Support – Will pass in 1-6 weeks with consistency

When to Call Your Pediatrician

Most sleep disruptions—whether teething or regressions—are normal and temporary. But sometimes, sleep issues signal a bigger problem.

🚨Red Flags – Call Immediately:

• Fever over 100.4°F (especially in babies under 3 months—this is a medical emergency)
• Refusing all feeds for 24+ hours (risk of dehydration)
• Severe diarrhea or vomiting (more than 3 episodes in 24 hours)
• Excessive crying that can’t be soothed (could indicate ear infection, UTI, or other pain)
• Lethargy or difficulty waking (unusually drowsy, won’t wake for feeds)
• Blood in stool or vomit

📞 Schedule an Appointment If:

• Sleep issues persist beyond 6 weeks with no improvement
• Baby isn’t gaining weight appropriately
• You’re concerned about developmental delays
• Gums are severely swollen, bleeding, or discolored
• Your mental health is suffering (postpartum depression/anxiety is real and treatable)

Key Takeaways: What You Need to Remember

Let’s wrap this up with the most important points:

• ✅ Duration is your biggest clue: Teething = 2-3 days of peak pain. Regression = 1-6 weeks of adjustment.
• ✅ Check for physical signs: Swollen gums, drooling, biting = teething. No physical symptoms = regression.
• ✅ Age matters: 4, 8, 12, 18 months are prime regression ages. Teething can happen anytime.
• ✅ Teething pain needs relief: Gum massage, cold teethers, doctor-approved pain medication. Comfort your baby—it’s short-term.
• ✅ Regressions need consistency: Adjust schedules, practice new skills during the day, maintain your sleep routine. Don’t create new habits you’ll need to break later.
• ✅ When in doubt, call your pediatrician: True fevers, severe symptoms, or persistent sleep issues beyond 6 weeks warrant professional guidance.
• ✅ This is temporary: Whether it’s teething or a regression, this phase WILL pass. You’re doing a great job, even when it doesn’t feel like it at 3 AM.

You’ve Got This, Parent Warrior! 💪

Understanding what’s disrupting your baby’s sleep is half the battle. Now that you can tell the difference between teething and sleep regressions, you can respond appropriately—offering relief for teething pain or maintaining consistency through developmental leaps.

Sleep deprivation is exhausting, but you’re not alone. Every parent has been exactly where you are, wondering if this nightmare will ever end. (Spoiler: It does. And then they become teenagers. But that’s a different article.)

Your next step: Use the interactive tools above to diagnose what you’re dealing with, then follow the specific strategies for that issue. Within days (teething) or weeks (regression), you’ll have your good sleeper back.

Related Articles You’ll Find Helpful

1. The Complete Baby Teething Timeline (0-36 Months) – When to expect each tooth and what symptoms to watch for
2. 4-Month Sleep Regression: What’s Happening & How to Survive – Deep dive into this permanent brain change
3. 6 Natural Teething Remedies: Pediatrician-Approved Solutions – Evidence-based relief methods that actually work
4. When to Call the Doctor: Baby Fever Guide for Parents – Clear guidelines on when symptoms need medical attention
5. Baby Won’t Sleep Through the Night: 8 Common Causes – Beyond teething and regressions—other sleep disruptors

Sources & Research

This article is based on peer-reviewed medical research and guidance from leading pediatric organizations:

1. Ramos-Jorge, J., et al. (2011). Prospective Longitudinal Study of Signs and Symptoms Associated With Primary Tooth Eruption. Pediatrics, 128(3), 471-476.
2. Macknin, M. L., et al. (2000). Symptoms Associated With Infant Teething: A Prospective Study. Pediatrics, 105(4), 747-752.
3. American Academy of Pediatrics. (2025). Teething Pain Relief: How to Soothe Your Baby’s Discomfort. HealthyChildren.org.
4. U.S. Food and Drug Administration. (2024). Safely Soothing Teething Pain in Infants and Children. FDA Consumer Updates.
5. American Academy of Pediatrics. (2022). Separation Anxiety & Sleeping Trouble in Young Children. HealthyChildren.org.