Dr. Sarah Mitchell
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The Truth About Teething and Sleep Training

The first signs of teething arrive around 4 months when your baby will start drooling like Niagara Falls and be constantly shoving her hands in her mouth.

When I saw these signs, I was excited and proud that a tooth was imminent! And then I waited and waited and waited….

My anticipation was a rookie mistake, as most kids will drool like that for about 2 months until the first tooth actually materializes, generally around 6 months.

Chronic Teething vs Acute Teething

That being said, this timeline is general as there are large variations in tooth appearance related to your genetics, but most of us will overestimate the arrival of that first tooth, which will be the bottom middle teeth aka lower central incisors.
I refer to this stage of teething as chronic teething, all that drool and no rewards.

Acute teething occurs when the tooth is piercing through the gums. This is the most painful part of teething and usually, lasts 1-2 days. It’s a hard diagnosis to make since you can’t be 100% sure that the pain / poor sleeping is related to teething until the tooth pierces through the gum and you can see it, and by then the pain is receding.  It is a hindsight diagnosis.

How does teething interrupt your baby’s sleep?  

Your baby surfaces from a sleep cycle and is distracted by the discomfort in her gums, and can’t relax to drift back off into sleep. It’s the same way she would be unlikely to fall back asleep if she had a soiled diaper, or if she was learning a new motor skill and thinking about that skill.

Helping Babies Sleep - Baby Sleep Eruption Schedule
http://www.mouthhealthy.org/en/az-topics/e/eruption-charts
COMMON TEETHING TIMES THAT CAUSE BLIPS IN BABY SLEEP:
6 MONTHS – MIDDLE BOTTOM TEETH AKA CENTRAL INCISORS

9- 11 months – A boat load of teeth coming in – upper front teeth, upper lateral teeth, and bottom lateral. There is a very long stretch of early morning wake ups around 5 am in these months related to the onslaught of teeth coming through.

15 monthsfirst molars generally appear around this time. Where your child’s hands may be in her mouth consistently during the early teeth. I find with molars, they often only point to them at bedtime. The most common sleep disruption at this stage is at bedtime, and early wake ups, naps aren’t as affected as much as earlier on.

2 years Second molars. There’s more variation as to when these may appear, anywhere from 2-2.5 years. And these are nasty. They are also aligned with  The 2 Year Old Sleep Regression.

Some signs of teething affecting sleep include:

  1. Short 30 minute naps, where your child was previously napping consistently for at least 45 minutes or more.
  2. Trouble settling at bedtime, when your child was previously, settling easily without any help.
  3. Night wakings where she was sleeping uninterrupted or with only 1-2 night wakings.
  4. Early morning wake ups, before 6 am. There are other things that cause EWU (early wake ups).

The distinguishing features here is that in a child who is “sleep trained”, and therefore can fall asleep 100% by herself without having rocking, nursing or a bottle in her bedtime routine (by the way – it doesn’t matter if her eyes are open when she’s put in the crib),  doesn’t wake up every 3 hours at night, even when she’s teething.  Whomp – there it.  Every 3 hours is a sign of a Sleep Crutch Problem.

There is no doubt that teething affects your child’s sleep, but it is not nearly as much as most people think.

The classic misinterpretation of teething goes something like this:

“My baby is 7 months old, never been a great sleeper, but now she’s waking up every 3 hours at night.  I’m pretty sure she’s teething.  I can just wait this out, right?”

These types of questions are hard to answer because I need so much more information.  I need a full history to tease out what is really happening here.

Most importantly, I have to find out if she ever fell asleep by herself and if she’s ever been able to sleep 11-12 hours with 2 or less night wakings.  The answer is usually no.

Often what happens at 7-10 months, is that what you were previously doing, becomes less effective in getting your child to fall or stay asleep.  Often the parent will start to see waking every 3 hours at night.  This is a sign that your child’s in a cycle of being overtired, and waking up after a 3 hour night time sleep cycle.  These kids usually need help falling asleep at bedtime, either by nursing or rocking, and then needs that same help falling asleep.

But from Mom’s perspective, she maybe didn’t wake up this much before OR because she’s getting older. Mom expects her baby to be sleeping longer stretches.  When she doesn’t sleep longer stretches and sees a finger in the mouth here or there, she assumes that this must be teething being the cause of bad sleep.  Okay okay… I’m making a TON of generalizations here… and yes there are deviations, but this is the majority of issues that I see at this age.  I’m hoping you can roll with me.

Can you sleep train when your baby is teething?

Obviously, we would love to avoid teething when we are working on your child developing a new skill – the skill of relaxing herself into sleep with rocking, nursing or a pacifier.  The best time to sleep train is when there are the least amount of variables at play.  Variables such as teething, motor development, life change, etc. However, that chronic teething is going to go on for months, and you will reach a point where you and your child, just REALLY NEED SLEEP!

And let’s not forget that the chronic teething isn’t really that uncomfortable, but the ACUTE teething is.  Remember how long that acute teething lasts?  Right, usually just 1-2 days.  So avoid those 1-2 days and then GO FOR IT, with respect to sleep training.

I’m a chiropractor by training, I have 8 years of university health education behind me.  I believe in living as naturally as possible, but when it comes to teething, I am all about pain medication for my kids for that acute period. This is because they (and I) need sleep, and that’s one variable that I can control.  You should talk to your pharmacist about the best options for your family.

Moral of the story:  

Yes, teething derails things a bit, but it is not as long as one might think. It is not a reason to continuously delay sleep training a poor sleeper.  You could be waiting for a long time since the poor sleeping is minimally related to the teeth.

Share your thoughts on Teething and Sleep Training in the comments below. Want to add something? Feel free to share.

Online Sleep Class for ages 4-24 months: Tell Me More

Photo credit: Baby portrait   © Maram | Dreamstime.com

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