January 2005

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Teething: Pediatrician addresses fact, fiction

ByAnissa Anderson Orr

The drooling. The biting. The constant crying. Teething can be a grueling experience both for babies and parents.

Or, it can pass by almost unnoticed, taking parents by surprise when their baby flashes them that first toothy smile.

So is teething the dreaded source of most baby maladies, as folk wisdom dictates, or just a convenient scapegoat for parents who can't explain their baby's fussiness?

It's a little of both, said Teri Turner, MD, an assistant professor of pediatrics at Baylor College of Medicine in Houston.

In folklore, teething has been linked to a wide variety of problems in infants, ranging from fever and diarrhea to even death. It was not until the 1960s, Turner said, that studies revealed that teething has little effect on the health of infants.

"The first real study on teething was published in 1968, and we really didn't have anything else until 1992," Turner said. "So it is a topic about which we just don't have a lot of information from evidence-based research."

Teri Turner, MD

Based on the studies doctors do have, the consensus is that teething is a natural part of a child's development and is not harmful.

Try telling that to a sleep-deprived parent caring for an inconsolable baby.

In fact, teething is not always at fault.

In some cases, babies start to drool at around three months, whether or not they are teething.

Many babies who have been sleeping peacefully through the night may begin to wake up several times between the ages of eight to nine months, a time when they may be cutting teeth and coincidentally developing separation anxiety. Babies often wake up when they realize their parent is gone.

How can you tell if your baby is really teething? Drooling, gum rubbing, sucking, irritability and a decreased appetite for solids are common symptoms. Some babies may also have a slight increase in body temperature, "but anything above 100 should not be attributed to teething," Turner said.

Studies also show that diarrhea, long thought to be a symptom of teething, is not caused by it. Do not hesitate to call your doctor if your baby is running a fever or has diarrhea, Turner said.

"No physician will be upset if you come to your doctor if you think your child is ill."

Teething timetable

In most babies, teething starts during the first four to seven months. The two bottom front teeth (central incisors) show up first. Four to eight weeks later, the four upper teeth (central and lateral incisors) appear, followed about a month later by the two lower incisors.

Next, the first molars come in, followed by the canine, or eye, teeth. Most children have all their baby, or primary, teeth by age three.

Every child is not the same, however. Do not worry if your baby doesn't develop teeth according to schedule. Heredity plays a big part in how early, or late your baby starts cutting teeth. Some babies are actually born with a tooth or two. Others do not get any teeth until they are more than a year old.

Babies also experience teething differently. Only 35 percent of babies have teething symptoms, Turner said.

"For a parent, it can be a very difficult time," Turner said. "Your children can't talk. They can't tell you why they are fussy or why they may not be eating as much."

Teething pain is worse when the first set of teeth and the molars come in. Pain is often most intense the day the tooth breaks through the skin.

Teething tips

Parents will probably need to try many approaches to soothing their teething baby, before settling on one method. What works to calm one baby might not work on another.

"The primary advice parents should remember is to do no harm when treating children who are teething," Turner said. "In any remedy you use, think about the choking hazards and side effects before you try it on your baby."

She recommends letting your baby suck on a cool teething ring to help relieve the pain and swelling of teething. The teething ring should be new, because the gel in models manufactured in 2000 or earlier was found to be carcinogenic (cancer-causing).

You can refrigerate the ring, but don't freeze it. Infants are more sensitive to frozen objects. If your baby is at the stage where she can chew food, you can also give her a cold banana on which to suck or chew. While frozen bagels are commonly recommended as teething objects, pieces that break off can pose a choking hazard.

Turner also recommends applying gentle pressure to your baby's gums with a cold cloth to help relieve teething pain. She doesn't advise using topical teething gel, which you apply directly to your baby's gums.

"The problem (with teething gel) is that your baby is drooling and it gets flushed off," Turner said. "And you can't use it very often because it contains an anesthetic. If parents decide to use this product they should not use it more than four times a day."

Parents can give their baby acetaminophen to help relieve teething pain at night. Give pain relievers to your baby when her pain is the worst, and don't give it to your child too frequently because, "you don't want to mask anything that could be a symptom of a serious illness," Turner said.

"Teething is a difficult, but natural process," Turner said. She has some parting words of advice for parents at their wits end. "Remember, this too shall pass."

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