Getting to Know Your Little One

The first few weeks of your newborn’s life are an exciting time. Being responsible for this tiny creature can also be a little scary, particularly if you’re not familiar with how a newborn looks and behaves. After all, they don’t come with a manual. Google is a great resource these days. We did not have access to the information when my daughter was a newborn, as we do now.

If you feel anxious or uncertain about any part of caring for your baby, don’t hesitate to call your health care professionals, family, or friends who have had experience caring for a newborn.  Everyone has an opinion, so take advice with a grain of salt, use what works for you, and file the rest.

Your Baby’s Mouth is important

What to Expect:

If you’re a new parent, there can be a lot of things to worry about. Although infants usually do not have teeth when they are born, it is still important to care for their mouths from the start. 1 in 3000 babies is born with a tooth.

We will talk more about teething in next week’s episode.

As soon as your baby is born, it is ok to look inside their mouth. I recommend you look to see if they have any tethered tissues. What does that mean, a lip or tongue tie? As with most topics, there are different opinions on the subject. If your baby is having trouble latching, this is the first place I would investigate. If you are nursing, it should not be painful to the Mom. If you are bottle-feeding, you may need to change the size or shape to get a better latch. I talked about the difference between breast vs. bottle feeding last week and recommended some books as resources on nursing. Diane Bahr is an amazing resource on infants’ mouth growth and development.

If your newborn has a tethered lip or tongue, it can have many effects as they grow; other than latching, it can affect their eating habits, swallowing, speech and breathing.

Getting it released at an early age, while hard for a parent, is much easier on the child as they will not even have a memory of the event. I recommend working with an oral myofunctional therapist to help with proper positioning and posture.

What else might you see in your little one mouth? When your newborn opens their mouth to yawn or cry, you may notice small white spots on the roof of the mouth, usually near the center where the tongue rests.  These small collections of cells called Epstein’s pearls with fluid-filled cysts sometimes present on the gums will disappear during the first few weeks.

What to look for:

There are a few specific things to look for:

  • Epstein pearls: Small, white cysts in the baby’s mouth that are usually harmless and disappear on their own
  • Lip or tongue-tie
  • It the tongue up or down
  • Bohn nodules: Small, grayish-white nodules that can occur on the palate and are usually harmless as well
  • Inclusion cysts: Small, harmless bumps on the gums
  • Natal/Neonatal teeth: Some infants are born with teeth, or their teeth begin to erupt within thirty days of birth. In some cases, these teeth may need to be removed.
  • Is their mouth open or closed at rest

If you are concerned about anything, see your healthcare professional.

Your Baby’s Mouth During The First Year


During the first year of life, your baby will likely experience teething, which is when their teeth begin to erupt through the gums. This usually occurs between 3 and 9 months and will likely cause your child some pain or discomfort. Signs of teething include irritability, loss of appetite, excessive drooling, and restlessness. 

  • As teeth appear in the mouth, your baby may have some discomfort. Your baby’s gums will be sore, and he/she may get cranky or fussy.
  • It often helps if you gently rub the baby’s gums with a clean finger. Sometimes it’s helpful to give the baby a clean, cold object to chew on. Try giving a teething ring that you’ve kept in the refrigerator or a non-sweetened teething biscuit.

Teething doesn’t make a child ill, just uncomfortable. Often it seems as if they may have a  mild fever along with drooling and chewing. Fever and diarrhea are not normally a sign of teething. Yet, there are a few reasons teething and diarrhea seem to appear to happen simultaneously. We often start to offer our little solid food around the same time. Your baby’s digestive system may be sensitive to the new foods you are introducing, which can lead to loose stools. 

If your child seems ill or is extremely fussy for more than a day or two, call your doctor. Something other than teething may be causing the problem. 

So what are normal signs of teething?

If you suspect your little one is teething, look out for:

  • Putting things in their mouth
  • Drooling
  • Crankiness / Irritability
  • Trouble sleeping
  • Loss of appetite
  • A slight elevation in temperature around 99 F, teething temp is never above 100.4 F

The two bottom teeth are usually the first to appear.

When teething biscuits, teething rings, pain medicine, eating cold foods, or massaging the gums seem to work, talk to your Dr. or Dentist about how to best relieve your baby’s teething pain. 

When to call the Dr.?

  • Diarrhea lasts longer than two weeks
  • Your baby has a fever longer than 3 days
  • They develop a rash
  • Your baby is dehydrated
  • Your baby is losing weight or not gaining weight
  • Your baby seems to lack energy or is not responding to stimulus


Most babies get their first tooth between 4-7 months. There is a wide range of “normal.” So if your baby does not get their first tooth before they turn one, don’t panic is ok. My daughter did not get her first tooth until she was 13 months. Just know if your little one gets their baby teeth later, they will get their permanent teeth later and not lose their first tooth when the other kids are. My daughter was seven and in second grade before she lost her first tooth. 

Another normal aspect of an infant’s life is sucking on a pacifier, thumb, or fingers. This is not something to be concerned about; sucking is a natural reflex for babies. These sucking habits are usually gone by around 3 or 4 years old, and if stopped at this age, they will likely not affect the jaw or teeth. However, if a prolonged sucking habit continues, it can cause:

  • misaligned upper and lower jaws
  • bottom front teeth to slant inward
  • top front teeth to slant out
  • High or vaulted palate or roof of the mouth

These bite problems may need to be corrected with orthodontic work in the future. There are things you can do at home we will discuss in episode 1 -3 years.

Another common problem that can occur with your baby’s teeth is baby bottle tooth decay. This frequently occurs when a child is repeatedly put to bed with a bottle, and the sugars in the milk or juice sit on the child’s teeth for a long period of time, eventually causing tooth decay or cavities. This can be prevented by not giving the child a bottle in bed, as well as wiping out your baby’s mouth and brushing their teeth twice a day when they come in.

How to care for your baby’s mouth and tongue

Even before your infant’s teeth begin to come in, you should begin cleaning your infant’s gums soon after birth,  before any teeth have erupted. This will ensure your baby’s mouth is clean and get them used to you putting things in their mouth and the cleaning process. 

We recommend you clean your baby’s mouth at least once a day, preferably twice, with a clean gauze pad or soft washcloth. This will then become a regular habit and is not a huge shock when they get teeth.

Steps to clean your baby’s mouth: 

Cleaning a baby’s tongue and gums is a relatively simple process, and you don’t need many supplies. The only things you’ll need are warm water and a washcloth or a piece of gauze.

  •  First, thoroughly wash your own hands with soap and water. 
  • Lay their head down on a flat surface or in your lap. If someone is helping you, place the infant’s head in your lap with his feet toward your other person. It is important your infant is comfortable, and you can see into his/her mouth.
  • Place a clean gauze pad or soft damp washcloth over your finger. Dip the gauze in water so that it’s damp but not soaking wet. Wipe your infant’s upper and lower teeth and gums gently.
  • When your child’s teeth start coming in, switch to using a small, soft toothbrush to brush with water. Be sure to brush all surfaces of the teeth, inside and out, including the gums.
  • It is unnecessary to use toothpaste, but if you do, use a small amount of fluoride toothpaste (about the size of a grain of rice or a small pea).
  • Repeat these steps twice a day, in the morning and night
  • But babies have less saliva than you, making it harder for their little mouths to wash away milk residue. This can also build up on their tongue, causing what looks like a white coating. Cleaning their tongue loosens and removes the residue.
  • It’s important to note that a white coating on your baby’s tongue isn’t always due to milk. Sometimes, it’s caused by a condition called thrush.
  • Milk residue and thrush look similar. The difference is that you can wipe away milk residue. You can’t wipe away thrush.
  • Oral Thrush is a fungal infection that develops in the mouth. It’s caused by oral candidiasis and leaves white spots on the tongue, gums, inside of the cheeks, and the mouth’s roof. If the white does not wipe off, see your Dr.

As your child grows, you will want to supervise their brushing or let them brush, and you brush next. When they brush on their own, they generally miss the upper back teeth and the inside of the lower teeth. Children should be able to brush their teeth totally unsupervised by age 11. Until then, parents should watch or help based on their child’s abilities. I recommend checking to see where you occasionally miss a stain called disclosing when they are old enough to spit.

Babies are not born with the bacteria that cause dental decay. Instead, the bacteria are often transferred to them from their parents. When you clean their pacifier in your mouth when it falls on the floor, or even kiss them on the lips, share spoons or forks with your child, you can transfer harmful bacteria from your mouth without realizing it.

Thumb-sucking and Using a Pacifier

It’s natural for all babies to want and need to suck. Usually, there’s no damage to the teeth from thumb-sucking or using a natural-shaped pacifier unless this continues beyond 5 years of age. After age 5, the habit could affect the permanent teeth as they come in or create a tongue thrust swallow. You may need an oral myofunctional therapist to help stop the habit and retrain the muscles of the face.

Tooth Decay in Babies

A baby’s teeth can start to decay as soon as they appear in the mouth. Typically around 6 months of age. 

Decay begins when teeth are in contact with sugary liquids for long periods of time. If decay is not treated, it can destroy the baby teeth of infants and young children.

Although adult teeth replace them, baby teeth are a critical component of every child’s development. They help your child breathe, speak, chew, smile, and they hold space for the adult teeth.

Cavities are the #1 preventable childhood disease and infectious,  can spread – and can even cause infections in the adult teeth growing beneath them.  Compared to adult teeth, baby teeth are more susceptible to decay because they have a thinner layer of enamel, the hard outer surface of the teeth. The inner part of the tooth is softer, and decay spreads faster. Because of this, it is easier for baby teeth to develop cavities, which are formed when bacteria living in our mouths feed on the sugar, turning it into acid that weakens and erodes the surface of the tooth, creating a hole.

I will talk more about this in next week’s episode of caring for your child’s teeth 6- 12 months. The habit you establish the first few months will care through when your little one gets their teeth. 

Even though your child will lose their baby teeth, we need to take care of them as if they were permanent. Maintaining and caring for baby teeth falls on the adults who are caring for them. Simply keeping your own teeth healthy and brushing your teeth regularly can positively impact your child’s oral health. Our kids mimic what we do, so if they do not see you taking care of your mouth, they won’t think it is an important part of their daily routine. By helping prevent dental decay and forming good oral hygiene habits with your children, you can help them be successful, prevent disease and keep their smiles healthy for a lifetime.

Tips for Avoiding Baby Tooth Decay:

  • Never allow your baby or toddler to fall asleep with a bottle of milk, juice, or put any liquid that contains sugar or pacifier.
  • Please do not put a pacifier in your mouth to clean it. By cleaning the pacifier and putting it back in your baby’s mouth, you may pass disease-causing bacteria.
  • Start cleaning your baby’s mouth before their teeth appear, wipe your baby’s gums with a wet washcloth after each feeding. As soon as the first tooth appears, start brushing your baby’s teeth twice a day, morning and night. Until the child is three years old, use no more than a grain of rice.. the amount of toothpaste.
  • If your baby has sore gums when teeth begin to appear, gently massage the gums with a clean finger, damp gauze pad, or teething ring.
  • Check your child’s mouth and teeth regularly. If you see white or stained areas on the teeth at any time, get them checked.
  • Plan your child’s first dentist visit after the first tooth appears but no later than their first birthday. Your dentist will check for decay, other tooth problems and teach you how to clean your child’s teeth. Your dentist will also look at your baby’s tooth and jaw development.
  • Take good care of your own teeth. Continue to visit the dentist regularly after your child has been born. Setting a good example, keeping your own mouth healthy, your child has a better chance of having a healthy mouth.
  • Teething starts at around 6 months, when baby teeth will begin erupting and continue to 3 years of age. Usually, the first teeth to erupt are the bottom front teeth (incisors).
  • Between the age of 6 and 12, children have a combination of baby and adult teeth, as 32 adult teeth gradually replace their baby teeth. The front baby teeth (incisors) are usually lost between 6 to 8 years of age, and the back teeth (canines and molars) are not lost until ages 9 to 13.
  • Enamel, the strong layer that protects your teeth, is thinner in baby teeth than adult teeth. This makes them more prone to cavities.
  • Spacing between baby teeth is normal and allows space for adult teeth to erupt.

Teeth vary in size, shape, and location in the jaws. These differences enable teeth to work together to help you chew, speak and smile. They also help give your face its shape and form. At birth, people usually have 20 babies (primary) teeth, which start to come in (erupt) at about 6 months of age. They fall out (shed) at various times throughout childhood. By age 21, all 32 of the permanent teeth have usually erupted.

There are lots of changes happening between 3 and 6 months. Your baby’s brain is developing and taking control, and they are getting more and more curious. Meaning they will put more things in their mouth.

Between 4-6 months, the gag reflex will be stimulated further back on their tongue. You can protect your baby by not giving them things too small that will gag them or that they can choke on. The space between your baby’s mouth and nose increases. Their lips and tongue are beginning to move independently of the jaw.

Their mouth and digestive system are preparing for cereals and pureed foods. Check with your prediction on when to begin introducing these foods.

Between 5-6 months, your baby’s teeth are beginning to erupt—the process of biting and chewing helps the development of the jaw muscles. With an increase in biting and chewing, you can introduce soft foods or a baby arrowroot teething cookie. I started my daughter with, who again did not get her first tooth until she was 13 months, so she gummed it.

 A good diet is essential for a child’s growth and development – including their teeth.

We will talk more about this in next week’s blog 6-12 months

A healthy mouth is a healthy baby, a healthy body, and happy, healthy life.