Cutting Teeth, Part 2: Teething Today

In my last post, Cutting Teeth, Part 1: The Fascinating History of Teething, I examined over two millennia of mystifying myths about teething, as well as treatments that could be considered, by today’s standards, ghastly. Here is the long-awaited sequel–a look at some contemporary practices as well as what we think we know about teething.


SYMPTOMS

The medical literature about teething symptoms is sparse. However, there are a few studies that shed a little light on our questions:

  1. An article published in the journal Pediatrics in 2000, by Macknin, et al, entitled “Symptoms Associated With Infant Teething: A Prospective Study” showed that “symptoms of decreased appetite for solid foods, biting, drooling, ear-rubbing, gum-rubbing, irritability, rash on face, sucking, and abnormal temperature…and wakefulness were found to have some association with the teething process.” It is worth noting that the “abnormal temperature” was a slight increase in the child’s personal average temperature–not necessarily a fever.
  2. Pediatrics published another article in the same year by Wake, et al. This one was called “Teething and Tooth Eruption in Infants: A Cohort Study,” and the authors state that “this study did not confirm that tooth eruption in infants and toddlers is associated with fever, mood disturbance, an appearance of illness, sleep disturbance, drooling, diarrhea, strong urine, red cheeks, or rashes/flushing on the face or body.”
  3. A third study was published in Pediatrics in 2011, by Ramos-Jorge, et al. The authors of this study report that “the results of our study reveal a greater frequency of…sleep disturbance, increased salivation, rash, runny nose, diarrhea, loss of appetite, and irritability.” They did not find fever to be a symptom of teething.
  4. Most recently (and most importantly), a meta-analysis of all the available evidence looked at these three studies (among others) and concluded that some mild symptoms–like drooling, gum irritation, and mild irritability–are seen more commonly in children who are teething. They also noted a slight increase in body temperature (like 0.1-0.2 degrees), but nothing that would be considered a fever.

Essentially, if a baby has a fever (temperature greater than 100.4 F), rash, or diarrhea, or if he seems particularly irritable, it’s probably totally unrelated; although it could be indirectly related because he is exposed to more germs by putting his hands or other objects into his mouth.


TREATMENTS

But what about common treatments for teething used today? Do they work? Are they safe? Well, if you thought there wasn’t much evidence for teething symptoms, you’re about to be disappointed. It appears that the medical community has decided against gum lancing, hare’s brains, cocaine, and mercury-based powders. Here are some remedies I’ve seen, along with what we know about them:

  1. Hard liquor. Fortunately, this has become quite a bit less popular over the past few decades, but I’ve still seen it. Brandy, whiskey, rum…they may help you get through a night with a screaming baby, but you shouldn’t be giving them to your baby. An infant’s liver cannot process alcohol well, and it can become toxic even at very low doses.
  2. Amber necklaces. These have become quite common in recent years. They are made from beads of Baltic amber on a string, and they reportedly help teething by releasing succinic acid from within the amber to be absorbed through your child’s skin. I have a number of issues with amber necklaces. Regarding safety, they present a very real danger of strangulation or choking, both of which are worse than teething symptoms. And as for their effectiveness, the idea of a child’s body heat warming the amber enough to release anything doesn’t make sense; nor has succinic acid been shown to be an effective treatment for teething symptoms, especially in the minute doses that could plausibly be absorbed from these beads. (If you are interested in reading more about amber beads and teething, there are some great discussions here, here, and here.)
  3. Topical teething gels (Orajel, etc). These have a numbing effect and do provide some pain relief. They might actually help. However, most of them contain benzocaine, a medication that can cause a potentially fatal condition called methemoglobinemia in rare cases, even at the recommended dose. They are widely available, but I discourage their use due to this risk.
  4. Teething tablets (Hyland’s, etc). These homeopathic tablets are made from natural ingredients that the manufacturer claims help with symptoms of teething. There has been some controversy surrounding children that were potentially harmed by ingesting too much belladonna, one of the tablets’ active ingredients. It’s important for parents to realize that “homeopathic” isn’t just another word for “natural”–it’s a very specific subgroup of alternative medicine that goes against everything we know about physics, chemistry, and biology. Homeopathic treatments aren’t proven to be safe or effective, and they are not tested or regulated by the FDA. They probably won’t hurt your baby if used as directed on the package, but be aware of the risks, and realize that they won’t help either.
  5. Acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). These are commonly used medications for pain and fever. They have been proven to be safe at the recommended dosages, but both can be toxic in overdose amounts. Both of these medicines help with fevers and pain, and they may help to relieve some mild discomfort caused by teething (or pain/fever caused by anything else). Do not use acetaminophen under 2 months of age or ibuprofen under 6 months of age unless directed by your doctor. Do not use any medications containing aspirin in children. Keep all medications out of reach and double-check the dose for your child’s weight.
  6. Cold objects. These are probably both effective and safe, as long as they are chosen wisely. Teething toys designed to be placed in the refrigerator, cold washcloths, or similar items could provide some relief with very little risk of harm. Avoid ice cubes or other small objects that could present a choking hazard.
  7. Teething toys. Similar to the cold objects above, these seem to provide a benefit with very little risk. Choose toys designed for this purpose that don’t have small parts, sharp edges, or other dangerous properties. If nothing is available, most babies seem totally fine with using their hands or feet.
  8. Patience. This is the only remedy that works every time and has no potential risks (except of course, the risk of ignoring an important symptom because it was attributed to teething). As Voltaire wrote, “The art of medicine consists in amusing the patient while Nature cures the disease.” While I wouldn’t call teething a disease, his wisdom still applies.

Probably the most important thing parents can realize about teething is that, despite what your grandmother told you, it doesn’t cause severe symptoms. But no matter what’s causing the fever/fussiness/etc., the symptoms are real. For mild symptoms, it’s ok not to treat at all–but if you’re going to give your child a medicine, it’s important to choose one that is known to be safe and effective. And if you have any questions about your child’s health, be sure to ask your pediatrician–it’s what we do.


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As always, your comments are welcomed (even if you happen to disagree). I'll get back to you as soon as I can. Please try to keep it civil--I reserve the right to delete comments that are offensive or off-topic.

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