Alice Langford, Rebecca Gaines and Anna E. Mazzucco, PhD, National Center for Health Research
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 child is three years old. Although some children may not be affected by teething, others may show signs of discomfort such as fussiness, trouble sleeping, loss of appetite, and excessive drooling.[1] For these reasons, the teething period can be challenging for children and their parents!
Teething can last for months and has the same symptoms as other infant challenges, making it tough to know for sure what is bothering the child. The American Dental Association does not consider fever, diarrhea, or rashes to be signs of teething.[1] 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. Here are some tips on how to make teething as safe and comfortable as possible.
Just Say No to Orajel (Benzocaine) for Teething
Many parents reach for Orajel or Baby Orajel, which are teething gels that contain benzocaine and are designed to soothe sore gums. Benzocaine products have been used for years, but in May 2018, the FDA declared that over-the-counter (OTC) benzocaine products are a serious risk to children and infants and said that these products should be taken off the market.[2] They warned parents that benzocaine should not be used on infants and young children to soothe teething pain. The FDA is taking action against the use of benzocaine products because they have the potential to cause a condition called methemoglobinemia.
Methemoglobinemia is a potentially deadly condition that causes blood to carry less oxygen. Signs of methemoglobinemia may show either minutes or 1-2 hours after the use of lidocaine products. Symptoms include:
- Pale, gray, or blue-colored skin, lips and nail beds
- Trouble breathing
- Tiredness
- Headache
- Lightheadedness
- Racing heartbeat
If any of these symptoms appear after the use of benzocaine products, seek immediate medical care.[2] Products that contain benzocaine include: Anbesol, Baby Orajel, Cepacol, Chloraseptic, Hurricaine, Orabase, Orajel and Topex.
Lidocaine and Other Medications for Relieving Teething Pain? Proceed with Caution.
Are there any other medications 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.[3]
The FDA now requires a black box warning, which is the FDA’s most serious warning, for lidocaine solution. Lidocaine is a common painkiller that the FDA has never approved to treat teething pain but that parents sometimes used. 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,” including six deaths and 11 hospital admissions.[4]
Why is lidocaine dangerous, and why did it take 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, which can cause seizures, brain injury, or heart problems.
What about more traditional pain medication? Most experts believe that teething should not require medication, but some doctors may advise using a very low dose of acetaminophen (Tylenot) or ibuprofen (Advil) to relieve teething discomfort. Be sure to ask your child’s doctor before deciding to use any medication for teething. And, be sure to measure any medications very carefully, and don’t use them often, because infants can be harmed even by “over the counter” medications. Products containing aspirin should never be given to children unless instructed by your healthcare provider.[5]
What Can I Do to Help with Teething?
Fortunately, there are safe, non-toxic ways to treat teething. A simple do-it-yourself option is to wet one end of a washcloth or burp cloth and briefly freeze it before offering it to your baby to chew on. Commercial cloth products using natural fabrics are also available, including organic cotton varieties.
If a baby has started eating solid foods, offering a chilled puree or yogurt (as appropriate) can offer relief. For an added bonus, refrigerate the spoon first. If a child is old enough for a sippy cup, you can also serve them cool water to ease the pain.
The American Academy of Pediatrics (AAP) also suggests using clean fingers to gently massage gums, or using a chilled teething ring.[6] However, there are safety concerns about plastic teething rings. A 2015 study found endocrine-disrupting chemicals, which can affect the child’s hormones, in several types of plastic baby teethers.[7] For this reason, it makes sense to avoid using teethers.
The Bottom Line
Teething pain should not require 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. Additionally, don’t assume that products sold in your local drug store or online are safe.
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 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!
All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.
References:
- “Teething.” Mouth Healthy TM, American Dental Association, www.mouthhealthy.org/en/az-topics/t/teething.
- Commissioner, Office of the. “Consumer Updates – Do Teething Babies Need Medicine on Their Gums? No.” U S Food and Drug Administration Home Page, Center for Biologics Evaluation and Research, 23 May 2018, www.fda.gov/ForConsumers/ConsumerUpdates/ucm385817.htm
- U.S. Food and Drug Administration. (June 2014). FDA recommends not using lidocaine to treat teething pain and requires new Boxed Warning. Retrieved from 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 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
- “Teething Pain.” HealthyChildren.org, 28 Nov. 2015, www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/Pages/Teething-Pain.aspx.
- Swanson, Wendy Sue. “How to Help Teething Symptoms without Medications.” HealthyChildren.org, American Association of Pediatrics, 21 Nov. 2015, www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/Pages/How-to-Help-Teething-Symptoms-without-Medications.aspx.
- Berger, E, et al. (May 2015) Effect-directed identification of endocrine disruptors in plastic baby teethers. J. Appl. Toxicol.