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Continuity Clinic Notebook:

Chapter 1: The Prenatal and Well Child Visit


Chapter 1 Index

A. General Information about the well child examination

B. Nutrition Issues

C. Sleep Issues

D. Dental Issues

 

Teething

Introduction: There is no subject about which mothers and grandmothers feel more strongly. They know that symptoms are caused by teething, and there is no amount of rational discussion that will persuade them otherwise. Since teething is a process that goes on from 6 months to 5 years, it is difficult to know what people mean by the term.

Actual proven symptoms of teething: pain of gums when teeth are erupting with concomitant increased fussiness.  Drooling can increase as well.

Symptoms that are ascribed to teething:

  1. Salivation. Salivary glands start functioning about 4 months of age and drooling starts then. There is no relationship between the beginning of drooling and eruption of teeth.
  2. Fever. A number of controlled studies over the last 30 years have shown no increased fever in children whose teeth are erupting.  (Most recent: December 2000: Pediatrics).
  3. Diarrhea. Many parents are convinced that diarrhea is caused by teething.  As in fever, gastroenteritis occurs most often after six months of age, the time of tooth eruption.  Of course, this is also the time of changing foods.  There is no cause-effect relationship.  Despite this, a 1995 study found that 35% of pediatricians in Florida thought there was a cause-effect relationship.
  4. Facial rashes.  Drooling itself can cause atopic rashes, and since drooling does increase at the time of tooth eruption, this rash could be an indirect effect of teething.
  5. Susceptibility to infection. No evidence for this being true.

Recommended treatment for teething:

  1. Acetaminophen or Ibuprofen at the time of tooth eruption to treat irritability.
  2. Cold “teething ring” to soothe sore gums. -- Remember cold panniculitis.

Other treatments frequently used by parents (not recommended by most doctors):

Name of “Teething Treatment” Comments
Chamomilla Patients using homeopathy will use this a lot; many other homeopathy meds available
Viscous Lidocaine Seizures have been reported
Teething Powders (contained mercury) Pink disease
Paregoric Sedation, Intestinal paralysis, death
Benzocaine containing gel
- Orajel/Numbs-it
Methemoglobinemia reported
Whiskey on pacifier or just po This goes back many generations; often used
Honey on pacifier Botulism
Sugar on pacifier Can be soothing
Phenobarbital containing medications Sedation

Conclusion: Try and minimize dangerous treatments for teething. Otherwise, it is better to put your efforts elsewhere.  Combinations of mothers/grandmothers/nurses/etc are hard to beat.

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Department of Pediatrics  |  Medical College of Georgia
Please email comments, suggestions or questions to:
John T.  Benjamin M.D., 
jbenj@mcg.edu

February 27, 2004