Tuesday, May 20, 2014


     Teething in children occurs when the child drools more, chews on things, and fusses when their teeth develop under their gums. The average infant starts between 2-4 months with teething. On average, the first tooth breaks through near the center of the lower gums at between 6 and 7 months. However, it is normal to have teeth pop through anywhere between 2 months and 18 months. Once the teeth starting coming in, they will usually come in the following pattern and timing: 6 months -- 2 center bottom teeth. 8-12 months -- 4 top center teeth. 12-14 month -- 4 first molars come in. 15-18 months -- 4 eye teeth (canines) come in. 20-30 months -- two year molars come in. There is a great variation between children in when the teeth come in. We see 2 and 4 month olds in the office with baby teeth. We also see children who come in at the 15 month visit with no teeth.
     Like other conditions in children, how much it bothers each child is different. Some child sleep poorly, do not eat well, and fuss around excessively off and on. Other children seem to breeze through the teething. One of my children seemed to have an easy time with the front teeth but molars really bothered him.
     Over the years, we have been asked many, many times "Does teething cause ______?". Fevers, diarrhea, coughs, congestion, runny noses, throwing up, and rashes are often blamed on the teething. Teething does NOT cause a fever. Remember, we mean temperatures over 100.5 degrees. When a large study looked at children with fevers who were in that teething age (6-24 months), they found an illness (cold virus, ear infection, throat infection, etc.) in virtually all of the infants and toddlers. We think the excess saliva can cause more than usual spitting up, an eating change from teething pain could make the bowel movements more runny, and a little bit of congestion or an occasional cough. Truthfully, I think it bothers us as parents when our children become ill. We feel that somehow we have failed to keep them healthy. That drives us to blame something we cannot control -- "It must be the teething!". That way we feel better and we can better justify the symptoms. Also, it makes us feel like the child is not contagions. Also, realize that the symptoms of teething would last from 4 months until you were past your second birthday.
     So what to do for the teething? Each child seems to respond to different teething treatments, so you may need to try different things when your children are fussy with teething. Realize if they are drooling and chewing but not fussy, you need to do nothing but wait for the teeth to pop through. Many children will feel better if they are chewing on teething toys -- some children will want hard plastic toys, some will prefer the soft toys (even chewing on stuffed animals or a blanket), and some will like the teething helpers that you keep in the freezer or refrigerator to keep them cold. We think it is safe to use the occasional dose of Baby Oragel or Anbesol which contains benzocaine. Although there is a danger in over-use (it can numb the throat if small amounts are not used and this could lead to choking) and the rare chance that someone has methemoglobinemia and will react to benzocaine (as well as other medications), we have not had anyone have a dangerous reaction to these products over the years. We want you to be cautious about Tylenol or Motrin use for teething. If you use 2-3 doses in a week, I think that is fine. Daily, regular use for teething is not good for the stomach or kidneys(ibuprofen/Motrin) or liver (acetaminophen/Tylenol).
     One tricky issue is that many children will tug on their ears at the time of teething. If the child also has a runny or congested nose from a viral upper respiratory infection and is tugging on their ears, it is possible it is caused by the teething pain and not an ear infection. We are happy to see your child during walk ins or a sick appointment to confirm it is not an ear infection.
     Last but not least: here is a link to the Healthy Children website's info on teething. Call with questions!

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