A few years ago the Food and Drug Administration (FDA) warned parents against using over-the-counter liquid or gel benzocaine for their babies’ teething pain. This topical anesthetic — the active ingredient in Anbesol, Orajel, and (at that time) Baby Orajel — was shown to cause a potentially fatal condition called methemoglobinemia, which reduces the amount of oxygen that a child’s red blood cells can carry throughout the body. Subsequently, it was recommended that children under the age of 2 not be given topical benzocaine to relieve teething pain. (Although Baby Orajel no longer has benzocaine as its active ingredient, Orajel products for older children and adults still do have benzocaine in them. If parents use those products on their infants’ gums, methemoglobinemia can result.)
Last month the FDA renewed the warning about liquid and gel benzocaine, and added viscous lidocaine to the list of medications to be avoided for the treatment of teething pain in infants and young children. Viscous lidocaine is available by prescription and is used in older children and adults to topically treat oral ulcers, sore throats, and pain following dental and oral surgery. Robert Preidt tells why a warning was issued:
Parents who happen to have viscous lidocaine on hand may be tempted to use it to help teething babies, but they should not do so, the FDA said in a news release.
There have been reports of teething babies suffering overdoses of viscous lidocaine, according to the Institute for Safe Medication Practices. The FDA noted that in 2014 it received 22 reports of serious incidents, including deaths, tied to use of viscous lidocaine in babies and toddlers under three and a half years of age.
According to the agency, symptoms of overdosing include confusion, jitteriness, shaking, seizures, falling asleep too easily, vision problems and vomiting.
The FDA now requires a warning on the label of all prescription oral viscous lidocaine cautioning against its use in babies and small children for teething pain.
Viscous lidocaine also “can make swallowing difficult and can increase the risk of choking or breathing in food. It can lead to drug toxicity and affect the heart and nervous system,” Michael Cohen, ISMP president, said in the FDA news release.
The FDA also said that over-the-counter benzocaine products should not be used for children younger than age 2. These products include Anbesol, Hurricaine, Orajel, Baby Orajel and Orabase.
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.
The AAP recommends the use of cold teething rings or gentle massage of the infant’s gums with a clean finger for “teething pain.” No topical liquids or gels and no oral pain relievers like acetaminophen (Tylenol). In the “good old days” I remember grandparents pressuring their children (who were now parents themselves) to rub whisky on their babies’ gums. Apparently, they said, that worked wonders.
Do yourself and your baby a favor: don’t do that either!
(Back Pat: Dr. Ray O’Toole)