Dr. Greene, what can I do for the real bad teething times? My little girl did really well with some of her teeth, but she is in a lot of pain now. Wakes up every 2 hours and can not eat much. Is there any magic solution?
Theresa, Campbell – Durango, Colorado
Dr. Greene’s Answer:
No topic has gone through wider swings in medical opinion than teething. During the last century, teething was considered to be the leading cause of infant mortality.1 Most serious symptoms of that age group (including seizures and infantile paralysis) were blamed on teething.2 At the turn of the 21st century, the prevailing opinion has swung in the opposite direction, maintaining that teething probably does not produce any symptoms at all — even pain, crying, or problems sleeping.3 I’m glad that teething is no longer the wastebasket diagnosis it used to be, but I strongly believe that it can be an uncomfortable process for some children, and can cause low-grade fevers, increased mucus and saliva, and related symptoms.
There is some good scientific evidence to support this position4, but quality information is scarce. Young teethers can’t talk. We don’t know the moment teething pain starts and stops. Teething pain and its remedies are very difficult to evaluate scientifically. Therefore, we must rely on observation — general observations by many parents and care-providers, as well as specific observations of our own children.
Babies experience great pleasure and satisfaction through their mouths. Feeding brings them delight. Even when not feeding, sucking on a finger or pacifier can change crying to contentment. When babies grow enough to move about and explore the world, they do it by placing objects in their mouths.
When the mouth becomes a source of pain, it is quite unsettling for some kids. If you’ve ever bitten the inside of your cheek, you know how distracting a bit of newly irregular flesh can be. For a baby, the intrusion of a hard, sharp tooth through tender, swollen gums can be quite an adjustment. Some get used to it quickly, but at first it can be more uncomfortable than a pebble in a shoe.
The teeth (or tooth) that causes the most pain varies from child to child. It is often the first tooth that causes the most discomfort — or those big molars, when they arrive. For many babies, working on several teeth at once is the worst.
When they are teething, babies bring their hands to their mouths because pressure on the gums brings relief. Massage tends to be more soothing when it comes from someone else, and teething is no exception. A great way to comfort a teething baby is to rub the gums firmly and gently with a clean finger. The first few passes are sometimes a bit uncomfortable, but babies get more and more relaxed as the massage continues.
Providing cool things to chew on is another effective way to treat teething. Wet washcloths or terrycloth toys fresh from the fridge or freezer have been the most popular with babies and toddlers in my practice. Some are delighted with smooth, hard objects, like the handle of a hairbrush. I’ve not met many babies, though, who prefer soft plastic teething rings. Whatever you select, be careful that the object is not something your daughter might choke on.
Infant acetaminophen or ibuprofen can provide stronger pain relief on occasion, if necessary. All of these can also help with sleep.
Benzocaine teething gels are a bad idea. They do reduce pain, but they can also leave a baby’s mouth feeling as if she has just been to the dentist. Some babies object to the swollen, numb sensation as much as they do to the pain. Either way, the effect of these gels is very short-lived. And they do carry a small but real risk of allergic reactions and decreased gag reflexes.
As your daughter’s teeth come in one by one (or two by two), the brief discomfort the family experiences now is preparing your daughter for a lot of truly delicious family meals ahead of her. All too soon she’ll be saying, “Please pass the corn on the cob.”
1 Pediatric Dentistry. 1994 May-Jun;16(3):179-82
2 Diseases of Infancy and Childhood. 1869 Henry Lea, publisher
3 Your Child’s Health. 1991 Bantam Books
4 Archives of Diseases of Children. 1992 Feb;67(2):233-4