Definition

• Teething is the normal process of new teeth working their way through the gums
• Teeth come in between 6 and 24 months of age

Health Information

Symptoms

• Main symptoms are increased saliva, drooling, face rash and desire to chew on things.
• Sometimes, can cause mild gum pain. Most often, not enough discomfort to cause crying or keep from sleeping.
• Does not cause fever, diarrhea, diaper rash, ill appearance or lowered resistance to infection.
• Caution. At least one tooth should be seen before you blame any symptoms on teething.

Cause

• Most symptoms blamed on teething are due to something else
• Caution. Blaming teething for fevers can lead to a delayed diagnosis of other infections. Examples are ear infections, urinary tract infections and meningitis.
• Caution. Blaming teething for crying can lead to a delayed diagnosis of other illnesses. Examples are ear infections or other causes of pain.
• There are 2 reasons why infections start between 6 and 12 months of age. One is the loss of antibodies transferred to baby from the mother at birth. The other is the developmental milestone of chewing on everything.

Care Advice

1. Overview:
   • Teething is a natural process.
   • It’s harmless and it may cause a little gum pain.
   • The main symptoms of teething are drooling and rubbing the gums.
   • It does not cause fever or crying. If these are present, look for another cause.
   • Here is some care advice that should help.
2. Gum Massage:
   • Find the irritated or swollen gum.
   • Rub it with your clean finger for 2 minutes.
   • Do this as often as needed.
   • Putting pressure on the sore gum can decrease pain.
   • Age over 12 months. Use a piece of ice wrapped in a wet cloth to rub the gum.
3. Teething Rings:
   • Babies rub their own sore gums by chewing on smooth, hard objects.
   • Offer a teething ring, pacifier or wet washcloth that has been chilled. Chill these items in the fridge. Do not use items frozen in the freezer.
   • Age over 12 months. A piece of chilled banana may help.
   • Do not use hard foods that could cause choking. An example is a raw carrot.
   • Do not use ice or popsicles that could cause frostbite of the gums.
   • Avoid "teething necklaces". They have caused choking and strangulation. They are not helpful and not approved by the FDA. The latest are amber teething necklaces.
4. Cup Feeding:
   • If your baby refuses nipple feedings, try a cup.
   • A spoon or syringe can also be used for a short time as needed.
5. Pain Medicine:
   • Pain medicines usually are not needed for the mild discomfort of teething.
   • Fussiness often gets better with gum massage. If not, you can give acetaminophen OR ibuprofen. Just do this for one or two days. (Reason: Frequent use can cause liver or kidney damage).
6. Special Teething Gels - Not Advised:
   • You can get special teething gels without a prescription.
   • They are not advised for the 3 reasons listed below.
   • Most of them contain benzocaine which can cause serious side effects. Examples are bluish lips and skin, choking or allergic reactions. The risk of side effects is greatest for children under 2 years old.
   • These teething gels are not approved by the FDA.
   • Teething gels also do not work very well. At best, they provide partial numbing of the gums for less than 30 minutes.
   • Gum massage works better.
7. What to Expect:
   • Most often, teething does not cause any symptoms.
   • If your child is having some discomfort, it should pass in 2 or 3 days.

Call Your Doctor If

• Crying occurs
• Fever occurs
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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