Your baby is suddenly waking at night, fussy during the day, and refusing to nap. Is it teething or a sleep regression? Understanding the difference between sleep regression vs teething is crucial for knowing how to respond and help your baby get back to sleeping well.
Sleep Regression vs Teething: The Key Differences
While sleep regression vs teething can look similar on the surface—both involve sleep disruption and fussiness—they have distinct characteristics that can help you identify what's happening.
Sleep Regression Characteristics
- Occurs at predictable developmental stages (4, 6, 8-10, 12, 18, 24 months)
- Coincides with visible developmental milestones (rolling, crawling, walking, talking)
- Affects all aspects of sleep (bedtime, night wakings, naps)
- Lasts 2-6 weeks typically
- Often involves practicing new skills at night
- May include increased separation anxiety
- Baby is not in physical pain
Teething Characteristics
- Can occur at any time once teeth start coming in (typically around 6 months to 2+ years)
- Often preceded by drooling, chewing, and gum sensitivity
- May include visible swelling or redness on gums
- Usually affects only a few nights around tooth eruption
- Baby may have low-grade fever (under 100.4°F)[1]
- Discomfort is often relieved by pressure on gums
- Pain is typically worse in the evening and at night
What Research Says About Teething and Sleep
When considering sleep regression vs teething, it's important to understand what science actually shows about teething symptoms.
A landmark study published in Pediatrics followed 125 children through teething episodes and found that teething symptoms:
- Peak on the day of tooth eruption and the day before
- Are mild and don't typically cause significant systemic symptoms
- Include increased biting, drooling, gum-rubbing, and irritability
- Do not include high fever, diarrhea, or severe illness[2]
The research suggests that while teething can cause some discomfort, it's often blamed for sleep problems that actually have other causes. Many pediatric experts believe teething is frequently over-attributed as a cause of sleep disruption.[3]
How to Tell the Difference
When you're trying to determine sleep regression vs teething, ask yourself these questions:
Question 1: What's your baby's age?
If your baby is around 4, 8-10, 12, or 18 months old, a sleep regression is more likely. These are peak developmental periods when sleep disruption is expected regardless of teething.
Question 2: What developmental milestones is your baby working on?
Is your baby learning to roll, sit, crawl, stand, walk, or talk? Major motor and cognitive milestones are strongly linked to sleep disruption. If your baby is practicing new skills at 3 AM, it's likely a regression.
Question 3: How long has it lasted?
Teething pain typically peaks for 1-3 days around tooth eruption. If sleep issues have persisted for more than a week, it's probably not just teething.
Question 4: Are there physical teething signs?
Check your baby's gums. Signs of active teething include:
- Visible swelling or redness where a tooth is emerging
- Increased drooling
- Constant chewing on hands, toys, or anything nearby
- Fussiness when pressure is applied to a specific gum area
Question 5: How does your baby respond to comfort?
A baby in teething pain often finds relief from:
- Cold teething toys
- Gum massage
- Appropriate pain relief (consult your pediatrician)
If these interventions help significantly, teething is likely contributing to the discomfort. If they don't help much, a regression is more likely the culprit.
When It's Both
Sometimes the answer to sleep regression vs teething is "both." Teething often coincides with regression periods:
- 6 months: First teeth often emerge around the same time as the 6-month regression
- 8-10 months: More teeth may be coming in during this motor development phase
- 18 months: Molars can erupt during this toddler regression
When teething and regression overlap, your baby may experience more intense symptoms. However, the approach remains similar: address teething pain appropriately while maintaining consistent sleep habits.
How to Handle Sleep Regression
If you've determined that your baby is experiencing a sleep regression (not just teething), here's how to respond:
Maintain Consistency
Keep your bedtime routine and sleep environment consistent. Predictability helps babies feel secure during developmental upheaval.[4]
Give Time for Practice
If your baby is working on a new skill, give them plenty of opportunities to practice during the day so they're less compelled to practice at night.
Offer Comfort Without Creating New Habits
It's okay to offer extra comfort during a regression, but try not to introduce new sleep associations you'll need to break later.
Be Patient
Most regressions resolve in 2-6 weeks with consistent handling.
How to Handle Teething Pain
If teething is contributing to sleep problems, address the discomfort directly:
Before Bed
- Offer a cold teething toy or frozen washcloth during the bedtime routine
- Gently massage the gums
- Consider age-appropriate pain relief if recommended by your pediatrician
During the Night
- Administer pain relief if appropriate and recommended by your doctor
- Offer brief comfort
- Return baby to their sleep space
What to Avoid
- Teething tablets or gels containing benzocaine (FDA warnings)[5]
- Amber teething necklaces (strangulation and choking hazard)
- Assuming all fussiness is teething and missing other issues
Common Mistakes Parents Make
When distinguishing sleep regression vs teething, parents often make these mistakes:
1. Attributing Everything to Teething
Babies can be teething on and off for two years. If every sleep issue is blamed on teething, you may miss regressions or other problems that need different approaches.
2. Creating New Sleep Associations
Whether the cause is teething or regression, introducing new sleep props (nursing to sleep, bringing baby to bed, hours of rocking) can create habits that persist long after the original issue resolves.
3. Waiting Too Long to Get Help
If sleep problems persist for more than a few weeks, it's worth getting professional guidance. What started as teething discomfort or a developmental regression can become an ingrained sleep habit.
When to Seek Professional Help
Consider reaching out for support if:
- Sleep issues persist beyond 6 weeks
- You're unsure whether it's teething, regression, or something else
- Your baby seems to be in significant pain
- Sleep deprivation is affecting your wellbeing or safety
- You've tried various strategies without improvement
At Rose Sleep Co, we can help you identify the root cause of your baby's sleep challenges and create a personalized plan to address them. Schedule a free discovery call to get started, or reach us directly at (213) 935-0769.
Understanding sleep regression vs teething helps you respond appropriately to your baby's needs. Whether it's developmental growing pains or the discomfort of new teeth, with the right approach, your family can get back to restful nights.
References
- 1. Wake, M., Hesketh, K., & Lucas, J. (2000). Teething and tooth eruption in infants: A cohort study. Pediatrics, 106(6), 1374-1379. https://doi.org/10.1542/peds.106.6.1374
- 2. Macknin, M. L., Piedmonte, M., Jacobs, J., & Skibinski, C. (2000). Symptoms associated with infant teething: A prospective study. Pediatrics, 105(4), 747-752. https://doi.org/10.1542/peds.105.4.747
- 3. Owens, J. A., & Mindell, J. A. (2011). Pediatric insomnia. Pediatric Clinics of North America, 58(3), 555-569. https://doi.org/10.1016/j.pcl.2011.03.011
- 4. Mindell, J. A., Telofski, L. S., Wiegand, B., & Kurtz, E. S. (2009). A nightly bedtime routine: Impact on sleep in young children and maternal mood. Sleep, 32(5), 599-606. https://doi.org/10.1093/sleep/32.5.599
- 5. U.S. Food and Drug Administration. (2018). FDA warns about serious and potentially fatal side effects with the use of products containing benzocaine for teething pain. FDA Safety Announcements. Retrieved from https://www.fda.gov/drugs/drug-safety-and-availability
