Teething time--so much advice, but what really works?

Our baby is five months old and her first tooth is just pushing through.  She’s been pretty fussy and I notice that she’s putting her toys in her mouth and biting down on them.  She’s drooling a lot, too. She’s not waking up more than usual, (once a night to nurse) but I’ve heard so many stories about teething messing up sleep that I want to have a plan if the next teeth are more difficult for her.  When I’ve brought the topic up with friends or family I get a lot of strong opinions about what to do, what not to do, what works and what doesn’t--what are the facts?

The facts about teething are not nearly as interesting as the many opinions about teething. Teething, which means the eruption of a tooth, begins in most infants at around five to six months, so your baby is right on schedule.  Because this is a time when many other changes are occurring parents may assume that the changes are connected by cause and effect even when they are not.

The two common changes that occur whether or not a baby is getting teeth is the beginning of drooling--as a result of a bay beginning to produce saliva but not yet being able to swallow it--and bringing toys to the mouth, which is due to the development of hand-eye-muscular coordination. A baby with mouth toys and other objects as part of her exploration of the world.  

When a tooth emerges, the hard enamel of the tooth (which is formed in utero and almost complete by three months of age in full term babies) has to push through the soft tissues of the gums. Of course the baby may feel this, and it's reasonable to conclude that if a baby has an area in her gums that is red and swollen, that might be uncomfortable!  

Most children get their first primary tooth around 6 months of age and continue to get an average of one per month for the next two years, twenty teeth in all. Preterm infants usually get their teeth at their adjusted age.

If several teeth come in at times close together, a baby may seem more bothered, but that can also mean longer intervals between other teeth!  The lower central teeth  usually erupt first and the back molars last. Teeth tend to emerge in pairs, with the lower teeth erupting before the matching upper teeth. Interestingly girls often get their teeth earlier than do boys. 

So babies and toddlers will keep getting teeth for over a year, but that is different than experiencing teething discomfort continuously.   That's why trying to figure out if teething is the cause of other behavior or symptoms is difficult. It usually takes about three to four days from the time the tooth movement begins for it to emerge, and another three to four days before it is fully emerged.  So one week of teething per tooth means 20 weeks of teething.  Not a small amount if your baby is really bothered, but it is the rare baby who will have continuous teething discomfort when no tooth is on its way. A baby who seems to be continuously uncomfortable may have reflux, otitis media, or a persistent diaper rash as a cause of her irritability. 

In my experience, babies who are already wakeful during the night will be more troubled at night than during the day with teething pain because they are already easily aroused and less able to self soothe.  Babies who have been sleeping well (in at last 6 hour stretches) may wake more during the week of teething pain but will resume their previous patterns quickly.

In addition to having localized gum swelling and desire to bite down, other symptoms of teething may be irritability, decreased appetite, and increased night waking.  However, you should not assume that other symptoms such as fever over 101 F, diarrhea, vomiting, runny nose or significant crying during the day are caused by teething (unless you have seen this exact pattern with each previous tooth that has emerged.) It is far more likely that your baby has another illness and you should get appropriate medical advice.

Why does teething get blamed for symptoms that at any other age would make a parent think he was sick?  In part because this is a belief that has existed since descriptions of diseases of infants began to be recorded. The sad fact is that throughout human history, infant mortality has been at its highest peak during the same four to six month age range when teeth emerge.  Teething was blamed for illnesses that probably occurred because of the waning of passive immunity acquired from breastfeeding and exposure to other sources of infection, and perhaps because of the often toxic drugs and chemicals used to treat the symptoms.

When teething pain is occurring, it is difficult for babies and their parents.  So even though it is not a serious problem, it is nevertheless a significant problem.  So here are some ways of helping your baby.

One of the best treatments for local pain of teething is pressure, especially with chilled hard objects. The cold temperature of the object causes localized vasoconstriction, which decreases the inflammation, and biting on the object gives further relief by applying pressure to the gums. If you press on your baby’s gum with your finger and the pressure seems to relieve discomfort, then try:

• Teething toys, or any baby toy made of a hard substance such as rubber or silicone 
• A cold wash cloth that is dampened in one corner with water or chamomile tea
• A one piece pacifier
• A chilled (not frozen) teething ring

(Liquid-filled teething rings should be chilled in the refrigerator, not in the freezer, and should not be sterilized in boiling water or in the dishwasher because the extremes of temperature can disrupt the plastic material and lead to leakage of the fluid.)

All teething toys should be labelled as free of phthalate and BPA.  The Consumer Product Safety Commission has manufacturing requirements may be more effectively enforced on U.S.A. manufactured products than on imported toys. Always check any baby toys for small parts that can break off--and of course, supervise your baby’s use. 

Nursing may also alleviate pain, especially during the night.  However, be aware that your baby may quickly adapt to being nursed to sleep for comfort and may take in so much milk during the comfort nursings that you will have a sleep problem in addition to the teething problem.

“Alternative” approaches

Of course, in the Bay Area, approaches that are considered alternative elsewhere are quite common.  These treatments are considered safe and no adverse effects have been reported.  Whether they are effective is up to an individual baby!

Among them:

Homeopathic teething drops or tiny tablets, which many parents swear by. Although one company voluntarily recalled and reformulated their tablets because of possible adverse effects of the minute quantities of belladonna in the remedy, no association with negative side effects has been established.

Necklaces made of amber, believed to be a natural analgesic, which when worn next to the skin minimize teething pain.  Concerns have been raised about potential choking hazards if a necklace breaks, but I have not been able to find reports of this actually occurring.  If readers have other experiences I would like to hear from you. Parents who have found the necklaces helpful may choose to wrap the necklace around the baby’s ankle and cover with sock jammies with feet when the baby is not supervised or asleep.

Applications to gums of oils or solutions with clove, vanilla, natural licorice, and chamomile are often suggested, but finding a recipe that works for your own baby is guesswork at best.  If you are going to try homemade recipes, do your homework first about any cautions.  Any internet search that yields a recommendation should be followed by a search that combines the recommendation with the word “side effects” or “problems”.

Medications

Infant acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) can be extremely helpful for teething pain.  If a baby is suffering,the use of safe analgesics and anti-inflammatory medications is advised by every reputable medical professional, particularly those who have seen children undertreated for pain.  Use the correct dose recommended for your baby by weight, not age, and always double check the preparation label each time since dosage may different in different products. Parents usually find that one of these medications works best for their child, because each has a different mode of action.  The medications can be given at bedtime and repeated 6 hours later.  it should not be necessary to give for more than seven days unless multiple teeth are breaking through at the same time..

Teething gels with a numbing effect are popular, but if the active ingredient is Benzocaine the gel is not recommended because it may cause a rare but serious  condition called methemoglobinemia. Because the gel is used topically on an inflamed area, it is hard to calculate precisely the dose that is absorbed or swallowed.

Last, I will share with you my favorite (tongue in cheek) remedy for teething:  Pour an ounce of scotch, bourbon, vodka or gin over ice in a glass tumbler.  Dip your finger in the glass and massage the baby’s gums with the liquid.  Then drink the rest yourself!