By Rebecca Gaines and Anna E. Mazzucco, Ph.D.
Teething is the appearance of an infant’s first set of teeth (or “baby teeth”). This process can begin as early as three months of age, and may not be complete until the third birthday. Although some children may not seem affected by teething, others may show signs of discomfort such as fussiness, trouble sleeping, and a mild fever. For these reasons, the teething period can be challenging for children and their parents!
But since teething can last for months, and has the same symptoms as other infant challenges, it can be tough to know for sure whether a child is bothered by teething or for other reasons. One simple way to identify teething is to gently feel your child’s gums for swollen areas or an emerging tooth. If in doubt, and your child seems uncomfortable, you can always check with your pediatrician.
If your child is teething, it can be tough to sort through all the children’s products on the market today. Here are some tips on how to make teething as safe and comfortable as possible.
JUST SAY NO to Lidocaine for Teething
Some parents have used topical lidocaine to numb their child’s gums. However, in June 2014, the Food and Drug Administration (FDA) warned parents that lidocaine should not be used on infants and young children to soothe teething pain.
The FDA now requires a black box warning, which is its most serious warning, for lidocaine solution. Lidocaine is a common painkiller that the FDA has never approved to treat teething pain. The FDA now realizes that the risks of lidocaine are greater than its benefits for young children. The agency has received 22 reports of “serious adverse reactions,”1 including six deaths and 11 hospital admissions.
Why is lidocaine dangerous, and why has it taken so many years to realize it? The answer is simple: It is too easy for an adult or child taking care of an infant to give too much lidocaine, and this can cause seizures, brain injury, or heart problems.
Other Medications for Relieving Teething Pain? Proceed with Caution
Are there any other medications which can help? The American Academy of Pediatrics points out that topical medications, such as benzocaine, are not effective on gums because they wash out in a few minutes. These medications may have safety issues as well: Benzocaine liquids and gels can cause a rare but potentially fatal condition called methemoglobinemia.2
Some health care providers may advise using acetaminophen or ibuprofen to relieve teething discomfort, but be sure to ask your child’s doctor before deciding to use medication for teething. Products containing aspirin should not be given to children unless instructed by your health care provider due to the risk of Reye’s syndrome, a potentially fatal syndrome associated with aspirin use in children.
Soothing With Teethers: Home Remedies May Be Safest
There are safe, non-toxic ways to treat teething. The American Academy of Pediatrics (AAP) suggests using a chilled teething ring or “gently rubbing or massaging the gums with one of your fingers.”3 However, there are safety concerns about plastic teething rings. A 2015 study found chemicals which can affect the child’s hormones (also called endocrine-disrupting chemicals, or EDCs) in several types of plastic baby teethers.4 For this reason, parents may want to avoid using teethers made of any kind of plastic. While there are several non-plastic alternatives on the market which claim to be safe, some of these products may not have been adequately tested. In addition, some teething products could break or leak, presenting other safety concerns.
A simple do-it-yourself option is to wet one end of a washcloth or burp cloth and briefly chill it in the refrigerator before offering it to your baby. Commercial cloth products using natural fabrics are also available, including organic cotton varieties.
There are also several other household items which can help. For a baby who has started eating solid foods, offering a chilled puree or yogurt (as appropriate) can offer relief. Refrigerating the spoon first can also help! For a child old enough for a sippy cup, some cool water can have the same effect. And for babies who are breastfed, nursing can provide comfort as well.
The bottom line: teething pain should not need medical treatment. If your child is experiencing extreme pain or has a high fever, teething is probably not the cause and you should contact a medical professional. 3 Simple teething pain relief methods such as massaging the gums or offering a chilled washcloth, food or water are effective home remedies which don’t rely on plastic teethers. And a final thing to keep in mind: teething children may also stick other objects in their mouths in an effort to soothe their gums themselves, so watch out for potential choking hazards!
- U.S. Food and Drug Administration. (June 2014). FDA recommends not using lidocaine to treat teething pain and requires new Boxed Warning. Retrieved from href=”http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm%20%0d2″>http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm ▲
- Gaffney, Alexander. (June 2014). FDA Recommends Against Use of Painkillers for Teething Pain. Regulatory Affairs Professional Society. Retrieved from href=”http://www.raps.org/regulatory-focus/news/2014/06/19595/FDA-Warns-on-Painkillers-for-Teething-Pain/?utm_source=social&utm_medium=post&utm_campaign=RFnews”>http://www.raps.org/regulatory-focus/news/2014/06/19595/FDA-Warns-on-Painkillers-for-Teething-Pain/?utm_source=social&utm_medium=post&utm_campaign=RFnews ▲
- American Academy of Pediatrics. (December 2013). Teething: 4-7 months. Retrieved href=”http://www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/pages/Teething-4-to-7-Months.aspx”>http://www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/pages/Teething-4-to-7-Months.aspx ▲
- Berger, E, et al. (May 2015) Effect-directed identification of endocrine disruptors in plastic baby teethers. J. Appl. Toxicol. ▲