Teething…

IMG_4169 edited
 

This photo is missing a certain giraffe and several glasses of wine (for my consumption of course, not the baby)

 

We are going through the throes of teething right now… Baby I has all the symptoms: red cheeks, dribbling, chewing, irritability and… fever?

But is fever really a symptom of teething? Many will say yes, but when you actually look into it, fever should not really be a typical symptom of teething.

Firstly here are the typical stages of tooth development:

Typical Milk Tooth Development
Deciduous (milk) teeth start to fall out from around 6 years of age and are replaced by permanent teeth

Symptoms

I conducted a search to find evidence-based information on teething, its symptoms and how best to manage this stage of development. Interestingly but is very little information from the Royal College of General Practitioners, Royal College of Paediatrics and Child Health or even the British Dental Association, the clinicians who may encounter problematic teething children the most I would have thought…

However, I did find a good NICE (National Institute for Health and Care Excellence) document on teething which suggests the following¹:

Consider teething as a cause of discomfort in an infant up to the age of 3 years, only after other possible causes of signs and symptoms have been excluded

  • Ask about signs and symptoms associated with teething.
    • These generally start 3–5 days before each tooth eruption and include pain, increased biting, drooling, gum-rubbing, sucking, irritability, wakefulness, ear-rubbing, facial rash, decreased appetite, disturbed sleep, and (possibly) mild temperature elevation (less than 38°C).
  • Check the mouth for signs of tooth eruption.
    • Gums will be swollen and are tender to palpation.

Recommended Management:

  • Exclude underlying conditions – especially if high fever as teething has not been evidenced to be a cause of high fever
  • Self-care measures – this can include:
    • rubbing gums with a clean finger
    • biting on cool objects such as teethers, flannels and chilled fruit and veg (remember this should be supervised)
  • Analgesics –  oral paracetamol/ibuprofen solution (caution with ibuprofen especially if your child has asthma)

Interestingly NICE does not recommend the use of topical anaesthetics such as (like  Anbesol, Bonjela etc) as there are questions over their effectiveness as the gel/liquid is rapidly removed  by the tongue and saliva. There is also the potential risk of over use (I would strongly recommend sticking to manufacturer’s guidance if you do choose to use topical anaesthetic).

NICE also does not recommend the use of homeopathic treatments such as Teetha granules  as 2 RCTs (randomised controlled trial – the best type of scientific/medical experiment) in 1994 and 2005 failed to show any benefit when they were used for teething.

And there you have it! The researched evidenced-based advice. I must say that most of the refernces are quite old (the latest being a paper published in 2013), but I am glad to see that NICE plan on reviewing this guidance in December 2019.

However…

I will admit, that I have tried ALL methods, even those that aren’t evidence based as at times of desperation we will try EVERYTHING… The most important thing is not to cause harm by giving incorrect doses of any treatment and to ALWAYS stick to the manufacturers guidance.

Hopefully, we can all be reassured that teething is a transient phase of the normal developmental process and one day it will pass.

Good luck if you too are at this phase!

Xx

 

1. CKS.nice.org.uk. (2019). Teething – NICE CKS. [online] Available at:https://cks.nice.org.uk/teething#!topicSummary [Accessed 12 Mar. 2019]

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