Every two years or so, The PediaBlog revisits what to do — and more importantly, what not to do — about teething pain in infants. Most babies erupt their first tooth, usually a lower central incisor, by 8-9 months of age (though some can sprout teeth earlier and later and both are normal). Teething gets blamed for a lot of infant misery — none of it deserved:
Teething gets blamed for a lot of what parents perceive to be infant discomfort and fussiness. Symptoms of illness such as fever, excessive crying, decrease in appetite, disruption of sleep, rashes, and diarrhea are commonly blamed on teething. Interestingly, there is very little evidence that teething causes any of these symptoms. Indeed, teething is overrated as a source of misery in babies.
In 2014, the Food and Drug Administration renewed warnings to parents regarding the use of over-the-counter anesthetic gels containing benzocaine for teething pain. Two years later, we got to the bottom of teething pain:
Drooling. Irritability. Diarrhea. Fever. Rashes. Appetite loss. Disrupted sleep.
All of these symptoms (and more) are often attributed to teething. A recent literature review published in Pediatrics this month on “Signs and Symptoms of Primary Tooth Eruption” indicates that babies and toddlers experience very few symptoms directly associated with teething. Gum irritation and redness was the most common symptom reported, observed in 87% of children ages 0-36 months. In the assessment of 16 medical articles, 68% were noted to be irritable, and drooling was seen in 56% of the children studied.
Parents often attribute fever (defined as a temperature equal to or greater than 100.4 ºF) to teething. But the correlation of fever and teething, according to the study, is a myth.
In May, the FDA issued yet another warning about benzocaine-containing teething gels:
When a baby is teething, many a mom or dad reaches for a pain remedy containing benzocaine to help soothe sore gums. Benzocaine is a local anesthetic and can be found in such over-the-counter (OTC) products as Anbesol, Hurricaine, Orajel, Baby Orajel, and Orabase.
But the use of benzocaine gels and liquids for mouth and gum pain can lead to a rare but serious—and sometimes fatal—condition called methemoglobinemia, a disorder in which the amount of oxygen carried through the blood stream is greatly reduced. In the most severe cases, says FDA pharmacist Mary Ghods, R.Ph., methemoglobinemia can result in death.
And children under 2 years old appear to be at particular risk.
Instead, the FDA and the AAP suggest that parents gently massage the gums with a clean finger or provide a teething ring (cold is fine but never frozen) made of firm rubber to chew on. A short video from the FDA explains:
Teething is a normal part of childhood that doesn’t need a “cure” with prescription or over-the-counter (OTC) medications. FDA warns parents that benzocaine products are not safe for treating teething in children. There are safer, non-toxic alternatives.