**Firstly let me apologise for this being incredibly long winded**.

A comprehensive analysis of teething symptoms

This is one thing that all babies experience, and all babies cope with teething differently.  My 3 kids have reacted differently to teething.  My son always made a big fuss

with every tooth- pink cheeks, sleep disturbances, drooling, irritability, in every way he let us know that a tooth was coming.  My eldest daughter was the opposite.  She showed no sign of teething and we usually had no idea she was getting a tooth until she woke up with one in the morning.  Now we are going through teething for the 3rd time and my second daughter is letting us know she is getting teeth with different symptoms again. 

  Your child may have no symptoms of teething, or may have all of them.  As each child is an individual its difficult to predict.  Some of these symptoms are recognized by health professionals as being related to teething (through research studies) and others have been noted by experienced mothers who will tell you that even though the studies don’t say it’s due to teething, the symptoms are more than coincidence. 

  Baby’s first teeth are usually the lower incisors and appear from 5-7 months (give or take).  The top incisors usually appear around 6-9 months.  The first molar usually arrives around the first birthday and can make baby quite miserable.

  In this article I will present the symptoms of teething, treatments for easing the pain of teething and alternative diagnosis for teething symptoms.  I have used my own personal experience plus some health journal articles to make this as comprehensive as possible.

 

Symptoms: Cause, Treatment, Possible alternative diagnosis

 

Irritability

Caused by the pain of the tooth pushing on the gum.  First try distraction- play games, sing songs, offer exciting toys, anything to distract baby from his/her discomfort.  Try physical comforting- rocking, cuddles, feeding etc.  If that fails try some chewing methods as listed below, or paracetamol.  I have found that asprin (salicylates) based teething gels are not that effective, but our hospital make a great teething gel made from chlorhexidine and lignocaine ($7 from the Women’s and Children’s Hospital Pharmacy if you live in Adelaide).

Biting/chewing/sucking/Gum rubbing

Baby knows that pressure on the gums is a form of pain relief and will try to self medicate this way.  My daughter has been enthusiastically chewing her hand the last couple of days.

Babies may seek wooden furniture to chew on.  It’s common to have teeth marks on cot sides.  Our TV cabinet has teeth marks on the draw from when the twins were teething.  This is where it’s important to make sure all furniture is LEAD FREE. 

You could offer teething rusks, biscuits, a clean finger, cold dummy, clean wet frozen wash cloth.  Carefully watch your baby any time he/she has solid food to minimise choking hazards  Bottle fed babies might like to chew on a frozen bottle of water that has been tipped upside down prior to freezing so that the frozen water is in the teat.  Cold water filled teething rings do the same job.

At this stage your baby may pick up anything and put it into his/her mouth- part developmental-part teething relief.

An idea from a homeopathic journal article suggested one drop of peppermint oil diluted in one teaspoon of olive oil could be rubbed onto the gums for relief (2).

 Breastfeeding mums need to watch out for bites: this leads to painful nipples, blocked ducts and mastitis.  If bites do occur, try ‘Lasinoh’ on the nipples, airing nipples, nipple shields, pain relief and continue feeding as normal.

Drooling

Extra saliva is produced during teething. The extra saliva either has to be swallowed or is dribbled out.

Facial/neck/chest rash

 The constant moistness of dribble on the skin can lead to rashes (1).  Regular drying of dribble is recommended, and sometimes a barrier cream such as nappy cream, zinc based creams etc, can be helpful in preventing teething related rashes.  Replace wet clothes frequently.  The use of bibs is usually more convenient.

Nappy rash

Also related to the extra production of saliva.  The saliva increases the amount of ammonia in the urine which can burn the skin in the nappy area.  Try nappy free time to air the area, exposure to a bit of sunlight is also good (lay baby on the floor under a sunlit window with nappy off) and nappy rash creams can be used.

Smelly Urine

Same problem as nappy rash, it’s the ammonia that makes it smelly.  Smelly urine could also indicate a urine infection so don’t assume this symptom is teething related.

Decreased appetite for solids

During the days close to tooth eruption, your baby may go off solids (1).  As long as baby is getting enough fluids, a couple of days without the usual solids is not a problem.  Offer foods that baby likes.  Now is not the time for trying new tastes.  A good teething gel 15 minutes prior to offering solids may help.  Use a nice soft rubbery spoon.  Sometimes it helps if baby can hold a spare spoon during feeding.  Decreased appetite may also indicate the beginning of illness, so watch baby’s behaviour and other symptoms carefully.

Decreased appetite for liquids

The study by Macknin et al (1) showed no link between the emergence of teeth and decreased appetite for fluids.  If baby is not bottle feeding or breastfeeding as well as usual, this may indicate a problem unrelated to teething.  I personally believe that teething babies may have a decreased appetite for breast or bottle due to the need to chew rather than suck- leading to playing with their food.  Watch for signs of dehydration.

Higher temperature

A slight elevation in temperature can be related to teething and is quite common.  Any temp above 102 deg. F or 38.8 deg C is NOT related to teething and indicates an infection/illness (1).

Nasal congestion

There is a slight increase of incidence of congestion during teething but the found this was insignificant to the results (1).  Mums might argue.  I know my current teething baby seems to have a runny nose during every teething episode so far.  Other causes may include upper respiratory tract infection or allergies.

Cough

No association was found between cough and teething in the study (1).  One could theorise that the extra saliva running down the back of the throat may cause a reactive cough, but other causes such as respiratory infection may be more likely.

Loose stools/diarrhea

A statistically insignificant link was made between loose bowel actions and teething (1).  Some mums will note that every time baby seems to be teething, baby also gets diarrhea as well.  The theory is that the increased saliva in the gut affects digestion.  Illnesses such as gastroenteritis need to be ruled out before teething can be blamed.

Sleep disturbances

Sleep disturbances are related to pain and discomfort.  Night feeds may help to settle the teething baby.  Its difficult to start giving night feeds again once you have successfully weaned off of night feeds, but keep in mind this is only temporary and night feeds can be omitted again once the tooth has cut through.  Pain relief such as paracetamol and teething gels may be required for a peaceful, restful night sleep for everyone.

Vomiting

The theoretical link between vomiting and teething was also found in the study to be insignificant (1).  Other causes may need to be investigated such as gastro, reflux, food intolerance etc.

Ear pulling/rubbing

Another common symptom of teething (1).  I recently took my baby to the dr due to excessive ear pulling, even though I was 95% sure it was due to teething just to get her ears checked (she was fine).  Ear pulling/rubbing is also a symptom of ear infection and should not be ignored.  Other teething symptoms such as irritability, sleeplessness, decreased appetite and temperature can also mimick the signs of ear infection, so be wary.

Red cheeks

I think this is related to being in close proximity to the inflammation in the gums.  Also drooling on cheeks when lying on side can cause drool rash on the cheeks.  This symptom alone does not need treating, but keep an eye on the temperature as it may indicate an unrelated high fever.

 

The study (1) showed that true teething related symptoms were attributed to the 5 days leading up to tooth eruption and the 3 days post tooth eruption.  

 

References:

(1)- Macknin, M; Piedmonte, M., Jacobs, J; Skibinski, C, “Symptoms associated with infant teething: A prospective Study”, Pediatrics, 2000, vol. 105, no 4. pp 747-52

http://web.ebscohost.com/ehost/pdf?vid=20&hid=113&sid=acb6dbc4-3bc9-4cc3-a04c-2fd1a8e3fe65%40sessionmgr103

(2)- King, F, “Homeopathy: Homeopathy and Teething”, Chiropractic Journal, 1994, vol 8, no,5 p 21.

http://web.ebscohost.com/ehost/detail?vid=24&hid=113&sid=acb6dbc4-3bc9-4cc3-a04c-2fd1a8e3fe65%40sessionmgr103&bdata=JkF1dGhUeXBlPWNvb2tpZSx1cmwsdWlkJnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&AN=1998014874

 

http://web.ebscohost.com/ehost/delivery?vid=26&hid=113&sid=acb6dbc4-3bc9-4cc3-a04c-2fd1a8e3fe65%40sessionmgr103

(3)- Moore, A, “Tooth of the Matter”, World of Irish Nursing and Midwifery, 2007, vol. 15, no. 8, p.25

http://web.ebscohost.com/ehost/pdf?vid=30&hid=113&sid=acb6dbc4-3bc9-4cc3-a04c-2fd1a8e3fe65%40sessionmgr103

 

**One study showed that 48 out of 50 cases that presented to hospital with teething related symptoms actually had an underlying medical diagnosis for the symptoms, ranging from respiratory infection to meningitis (1).  Your baby’s symptoms may be teething, or may not.  Look at the big picture, take note of other symptoms and get your baby checked out by a dr if you have any concerns.**

Some babies have ended up in hospital with serious illnesses due to parents attributing symptoms to teething and did not get the child seen by a doctor. (3)

 

Some doctors will try to tell you that teething symptoms don’t exist (this is why I tried to find some research based evidence to prove some points), experienced mums and dads know better!!

Good Luck

Xx josie