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Teething can be a catch-all diagnosis

At the turn of the century, some 5 percent of all deaths in England were attributed to teething. I think we’ve moved beyond that, but the latest studies do little to clearly define symptoms associated with teething. Teething was and remains a catch-all diagnosis of sorts on the smallest of patients who, unfortunately, lack the ability to tell us what is really bothering them.

Even Dr. Spock says so
Babies whine, cry and drool; they don’t eat right and they wake up at night. For generations, parents have wondered why this is all happening and a logical explanation has been to blame it on teething. Dr. Spock gave support to this notion in his book, associating teething with crankiness, decrease in appetite and wakefulness. I must point out that he also associates teething with a lowered resistance to infection. There is no scientific evidence to support such a claim.

Even the American Academy of Pediatrics (AAP) does not provide clear information on this topic. In the AAP’s Caring for Your Baby and Your Child, it’s noted that teething can be the cause of low-grade fever, irritability, drooling, crying, bringing fingers to the mouth and pain. Yet another AAP publication, Guide to Your Child’s Symptoms, states that teething is not associated with fever or diarrhea but is a cause of fussiness and excessive drooling.

Finnish study agrees with Australian study
Then there is the first large study that was done in Finland in 1969 that found no association between teething and night waking. The current study is in agreement with this earlier one, noting that symptoms such as drooling and sleep disturbances represent normal developmental stages a child passes through rather than "problems" caused by teething.

Symptom management

But I can’t discount the fact that parents absolutely believe teething causes many of these symptoms. For the most part, there is no harm done in the ways parents try and comfort their babies. For example, it doesn’t hurt to offer a cool (not freezing!) teething ring to suck on, or let an infant chew on her fingers or even take a fussy infant out for a walk in the stroller. Even an occasional proper dose of a pain reliever won’t hurt.

Try not to let comfort measures interfere with your routine. For example, don’t start giving an 11-month-old baby a bottle again during the night because you may reinforce what may well be a problem behavior.

Serious symptoms are not due to teething
The real danger comes when parents attribute more serious symptoms to teething. By this I mean significant fevers that last more than 24 hours, a high fever in a young child, diarrhea–significant symptoms that may require prompt medical evaluation rather than a scapegoat diagnosis of teething.

Setting healthy dental habits early
When teeth do come in–and that varies tremendously from child to child–experts agree that it’s a good time to establish healthy dental habits. Don’t put a baby down for a nap or to sleep with a bottle of milk, juice or other sweetened liquid. The sugars stay on the teeth while the baby sleeps and can do serious damage.

Clean the baby’s new teeth with a soft wet gauze, infant toothbrush or cloth. There’s no need to use toothpaste yet. Too much toothpaste is not good for an infant or toddler because they end up swallowing a significant amount of toothpaste, ingesting the fluoride, which can be poisonous at high doses. As more teeth come in, you can begin brushing with a soft brush and a pea-sized amount of fluoride-free toothpaste and gradually have your child take over the job of brushing. Avoid fluoridated toothpaste until four to six years of age, when children can spit out without swallowing a lot of toothpaste.

Parents of children over six months of age who have well water at home or are on ready-to-feed formula should talk to their pediatrician about fluoride supplementation. The first check-up with the dentist should be at age three, or sooner if problems arise.

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Greg Germain, MD, is a pediatrician in private practice in New Haven and on the medical staff of Yale-New Haven Children’s Hospital.