Revisiting Teething: Part 3

Alternative medicines to relieve teething pain?

By Karolina Gonzalez, MAS

Note: We are not medical doctors. We are providing this information based on articles published in research journals. You should talk to your own doctor before you give any medications or remedies to your child.

As a mom, I totally understand parents have concerns when trying to help their children deal with teething discomfort. I’ve heard a lot of them telling others which of the alternative medicines available today are the best. But I’m sure many parents out there are wondering about how effective those options are. Do they really work? We want you to make an informed decision regarding the product you choose to relieve your child’s teething discomfort. So let’s take a look at what the scientific evidence tells us!

First of all, it is important to point out that even though many parents might think that “natural” options are safer than “drugs,” that is not true. There are, for example, highly toxic natural substances. You should also know that while the U.S. Food and Drug Administration (FDA) regulates "conventional" foods and drug products, it regulates dietary supplements under a different set of regulations, per the Dietary Supplement Health and Education Act of 1994. Manufacturers of dietary supplements, including herbal treatments, are not required to prove a product is safe and effective before it reaches the consumer. For example, there’s insufficient evidence to support the use of any herbal teething remedy as an effective method for treating teething discomfort (McIntyre & McIntyre, 2002). However, herbal compounds such as Chamomile (Matricaria Chamomilla) are still popular among certain communities to relieve infants’ teething pain.

Homeopathic teething tablets and gels, another type of alternative medicine, are also marketed to soothe pain, reduce inflammation and ease irritability associated with teething. Homeopaths treat disease using very low dose preparations administered according to the principle that “like should be cured with like.” The remedies are prepared by a series of dilutions and vigorous shaking. The more you dilute it, the greater is its strength (Vickers & Zollman, 1999).  

Homeopathic remedies are also regulated by the FDA. For example, Hyland’s Teething Tablets were voluntarily recalled by its manufacturer on 2010 to ensure all the lots of the product contained equal amounts of the ingredients. The product was re-introduced with a new formula in July 2011 when all concerns were addressed. According to the National Center for Complementary and Alternative Medicine (NCCAM) parents can safely use the tablets as well as the gel with young children. But there is currently insufficient evidence that homeopathy is clearly effective for any single clinical condition, including teething pain in infants (Ernst, 2010).

Amber teething necklaces are a traditional European remedy for relieving teething pain and widely available today. It is important to stress that these necklaces are designed to be worn, not chewed. They supposedly help to reduce teething pain due to an analgesic compound in the amber that is absorbed into the body through the skin. But according to research, there is currently no scientific evidence suggesting that such necklaces are effective for treating teething discomfort (Markman, 2009).

From my own experience, I can tell you that an extra dose of loving care and attention has been the most effective method for “treating” my now 11 month-old teething baby. But no matter which method you choose, remember to talk with your doctor before giving your child any medication. And feel free to tell us about your experience!

References:

FDA. Dietary Supplements. Available at: http://www.fda.gov/food/dietarysupplements/default.htm

McIntyre GT & McIntyre GM. Teething troubles? British Dental Journal. 2002;192: 251-255.

Vickers A, Zollman C. ABC of complementary medicine: Homeopathy. BMJ. 1999 October 23; 319(7217): 1115–1118.

National Center for Complementary and Alternative Medicine. Homeopathy. Available at: http://nccam.nih.gov/health/homeopathy#sideeffects

Ernst E. Homeopathy: What does the “best” evidence tell us? Med J Aust. 2010;192(8):458–460.

Markman L. Teething: facts and fiction. Pediatr Rev. 2009;30:e59-64.

 

 

Revisiting Teething! Part 2.

By Karolina Gonzalez, MAS
Some time ago we shared information about common ways parents may "treat" their teething infants. We discussed the pros and cons about the use of teething toys, pain medications and mouth gels. New information is available about the latter two, so we decided to share it with you today!

We want to remind you we are not medical doctors and we are not recommending the use of any medication, pharmaceutical or natural. We are just reporting what research tells us about those options, to help you to decide which of these methods, if any, to use with your own infant. Please consult your doctor before giving your child ANY medication.

Common Teething Medications
Acetaminophen: Pediatricians often recommend acetaminophen products, such as Tylenol, for infant and toddler teething discomfort. Until quite recently, there were two suspension strengths: one for infants (80 mg/0.8 mL) and one for children (160 mg/5 mL), which resulted in the potential for confusion, as well as the potential for an accidental overdose. In response to recommendations from an FDA Advisory Committee Meeting, since 2011, some manufacturers have changed the amount of acetaminophen in these medicines to one standard amount to help reduce dosing errors that can lead to accidental overdoses (Krenzelok, 2009). Infant drops, which contain 3 times more medicine than the children’s liquid, are being phased out and will no longer be available. You need to be aware that the dosing amounts are different depending on the concentration they are using. And please remember, even though teething pain might affect some children on-and-off for several months, acetaminophen is not appropriate for long-term pain-management.
Mouth gels: Even though teething gels have been popular, on April 2011, the FDA warned the public that the use of benzocaine, the main ingredient in over-the-counter (OTC) gels and liquids applied to the gums or mouth to reduce pain, is associated with a rare, but serious condition. This condition is called methemoglobinemia and results in the amount of oxygen carried through the blood stream being greatly reduced. In the most severe cases, this condition can result in death. Analysis of the incidence of adverse reactions to benzocaine and dose required to produce an adverse reaction revealed 132 cases of methemoglobinemia between November 1997 and March 2002. Only 69 of the reported events specified the dose used, but of those, 37 indicated use consistent with package directions (i.e. appropriate dosing) (Moore et al, 2004). As of today, the FDA recommends that benzocaine-containing gels and sprays not be used on children younger than 2.

References:

Krenzelok. The FDA Acetaminophen Advisory Committee Meeting – What is the future of acetaminophen in the United States? The perspective of a committee member. Clin Toxicol (Phila). 2009 Sep;47(8):784-9.

U.S. Food and Drug Administration. FDA Drug Safety Communication: Reports of a rare, but serious and potentially fatal adverse effect with the use of over-the-counter (OTC) benzocaine gels and liquids applied to the gums or mouth. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm250024.htm Accessed on May 27, 2013.

Moore et al. Reported Adverse Event Cases of Methemoglobinemia Associated With Benzocaine Products. Arch Intern Med. 2004 Jun 14;164(11):1192-6.

Additional resource:

American Academy of Pediatrics. Fever and Pain Medicine: How Much To Give Your Child. Available at: http://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/Fever-and-Pain-Medicines-How-Much-to-Give.aspx  Accessed on May 26, 2013

Revisiting Teething! Part 1

By Karolina Gonzalez, MAS

 

Is your little one too fussy? Always consider the “big picture” before blaming those tiny pearly whites

As a new mom I’ve already been there! When my baby starts getting fussy and irritable in the grocery store, there appears that helpful advice from an empathetic woman: “He must be teething! Have you tried this? And what about that?” Everywhere you go and your baby starts showing any disengagement cue, together with the excessive drooling and the desire to chew on something hard, someone shares with you a popular treatment to help him soothe his tender gums, right?

Parents and caregivers attribute a wide variety of signs and symptoms in young children to teething. Excessive drooling, runny nose, diarrhea, fever, and sleep problems are just a few examples. A few days ago I even heard a mom saying she was sure her baby gets constipated when teething.

Such parental beliefs are consistent worldwide, across all education levels, and for both first-time and experienced parents (Markman L, 2009). We’ve already mentioned in previous posts though, that results from research studies indicate that no symptoms are linked consistently with tooth eruption in all children. However, those popular beliefs might lead parents to try possible solutions that will not always help and in some cases, may even pose a risk for their children’s health.

Remember that young children are exposed to a wide variety of environments, illnesses and situations that may cause episodes of congestion, diarrhea or fever; and that local symptoms may occur, but systemic (whole body) symptoms are not caused by teething. This perspective will help you avoid using the “teething diagnosis” to explain either normal baby behavior or a serious illness that should be treated right away.

My baby’s first two lower teeth appeared when he was 7 months old. And even though we noticed one of his upper teeth coming in a few weeks ago, we can’t say more teeth have appeared yet at almost 10 months. I must say, though, as first-time parents, learning everything from scratch and getting to know our baby day by day, we’ve considered teething pain as the cause for him being pretty irritable at times!

Next time, we’ll continue with this series about teething, sharing an update regarding common over-the-counter medications used to treat teething pain in infants. Stay tuned!

References:

Markman L. Teething: facts and fiction. Pediatr Rev. 2009;30:e59-64.

The Truth About Teething Part II: Remedies and Realities

In part I of this series, we talked about how parents may "diagnose" infant teething as the cause of symptoms like fever, runny nose, diarrhea, skin rashes, irritability, and sleeplessness. Results from research studies have challenged parents' beliefs about teething, indicating that no symptoms are linked consistently with tooth eruption in all children. In this post, we'll look at some of the ways parents may "treat" their teething infants and how the research might help you to decide which of these methods, if any, to use with your own infant.

The Many Remedies for Teething

Parents don't have to go far for advice on treatments for infant teething. Family, friends, even strangers in the grocery store will readily share their expertise. Of course, all parents will try to comfort their teething babies, but sometimes their efforts to hold or rock their babies don't seem to be enough and they want to try something else. Before you read the rest of this post, we want you to know 2 things. First and foremost, we are not medical doctors. You should talk to your health care provider about ANY medication that you wish to give your baby. Second, we are NOT recommending any of these remedies. We are only reporting what we've found in studies on teething. That said, let's take a look at the pros and cons related to the top 3 most common "treatments" for infant teething.

1. Teething Toys and Objects

Pros: Nearly all parents think that their babies drool and want to bite on things while teething. A well known remedy for infant teething discomfort is to offer the baby something hard (and often cold) to chew on. Babies' gums tend to swell and become sensitive as teeth emerge and it makes sense that babies should respond well to biting down on something firm and cold. Many do. Dozens of teething toys can be found in any store that sells baby goods. Health care providers sometimes recommend cold hard vegetables or clean cloths that have been put into cold water. Many babies prefer to bite daddy's or mommy's fingers. Beware! You don't want to learn (the hard way) how effectively babies can bite down with those new teeth.

Cons: Parents need to be careful to avoid choking hazards or toys that can come apart. These toys also typically don't work if the baby is already very fussy or has awakened in the night.

2. Pain Medications

Pros: The most common medication given to babies to reduce pain and fever is acetaminophen (also called paracetamol) sold in preparations especially for infants and children. The effect may last for several hours. More than half of the parents in the studies we reviewed reported using acetaminophen occasionally to help their babies deal with the pain associated with teething.

Cons: Some parents reported that their babies' "teething symptoms" lasted for up to 4 weeks before teeth emerged. While considered by most pediatricians to be a safe medication for babies, acetaminophen is not meant to be taken for a prolonged period of time. If you think your baby needs any medication more frequently or for a longer period of time than is recommended, talk to your health care provider before you do anything that is not on the instructions provided with the medication. Also, clinicians worry that parents might delay taking babies with health concerns (like ear or respiratory infections) to the doctor if the symptoms seem to improve with the use of over-the-counter medications.

3. Mouth Gels

Pros: Just like acetaminophen, many topical gel medications, made to be put directly on babies' gums, have been around a long time and are considered to be safe by most pediatricians. They usually contain some kind of pain reliever (like lidocaine) and are formulated to stay on the babies' gums at least long enough for the pain reliever to take effect.

Cons: The medications in these gels only work for a short time and are washed off by the baby's saliva fairly quickly. Also, if teething is not the reason for a baby's fussiness, the gels won't work at all. There is also the possibility that tired parents might make a mistake and use the wrong gel in the baby's mouth. Obviously, you need to be careful when using any medication, for yourself or your baby.

Older (and not so good) Remedies

When I was a baby (long, long, ago), some parents used brandy or a sweet alcohol preparation to sedate babies who were teething. Grandparents or great- grandparents may be suggesting that you try alcohol. Resist the temptation to use anything to sedate your baby.

Bottles propped in babies' beds have also been used to keep fussy babies from bothering sleeping parents during the night. Leaving bottles of milk, juice, or formula in babies' cribs has been linked to cavities and damage to babies' teeth.

The Realities

Researchers believe that there are no diagnostic symptoms of teething that will show up in all babies and that most teething symptoms are short-term and fairly mild. Why then, are we so full of ideas about teething babies? The experts would say that parents who describe the "symptoms" of teething are actually describing the "symptoms" of being a baby.

Now, we don't mean to say that teething is easy or fun. Teething is tough, on babies and on parents and each baby will experience teething in a different way. When selecting a "treatment" for teething, parents should first rule out other causes for their babies' behavior. For example, a baby with a fever and a runny nose probably has a cold and parents need to watch for signs of a more serious infection. A baby with runny stools might have eaten something off the floor. Pain medications may not be useful if a teething baby is fussy because he is frustrated while trying to learn a new skill rather than by pain in his mouth. Those of you who have been reading the blog know a great deal about your babies. Be sure to consider the big picture before deciding to take action to "treat" teething.

Next time: We'll answer more readers' questions.

The Truth about Teething Part I: Is it Teething or Something Else?

Most parents dread their infants' teething. They anticipate sleepless nights and inconsolable crying. Parents have attributed dozens of symptoms to teething including drooling, biting, fever, runny nose, congestion, ear problems, diarrhea, skin rash, and vomiting. But what if some or all of those symptoms are not part of teething? In this post, we'll take a closer look at what parents believe about teething versus what the research tells us.

Teething Basics

Teething is more formally called "tooth eruption" and occurs as infant teeth move from the jaw through the gums and become visible in the baby's mouth. While all babies are different (as we always say), babies teeth typically start showing up when the baby is about 6 or 7 months old. Most often, the first teeth to appear are in the lower front of the mouth and a full set of baby teeth may take two years to emerge. Teething, therefore, goes on for many months. Of course, those of you who are already parents know that!

The Teething Experience


While researchers associated biting, thumb sucking, and drooling with teething 30 or 40 years ago, today's parents have expanded their ideas about teething to include a wide range of concerns. In an interesting study published in Pediatrics in 2000, researchers followed a group of children aged 6 to 24 months that attended childcare settings. Each weekday, they asked parents and childcare providers about symptoms commonly believed to be associated with teething. The children's mouths were examined daily by a professional to see if any teeth had appeared. The concept was to identify which symptoms were associated with teething and which were not. What did they find? Virtually none of the common symptoms assumed by parents to be related to teething was statistically associated with tooth eruption. Interestingly, when the parents who participated in the study were asked about their children's teething symptoms, they reported many of the common symptoms even though their own records didn't support the connection. Other studies also support the view that parents are likely to assume that many symptoms of illnesses (like colds and ear infections) are related to teething.

Why Study Teething?

Clinicians and researchers are concerned that some parents might dismiss symptoms of more serious conditions (like ear infections) as teething and delay taking their babies to the doctor. Other parents might give medications to babies unnecessarily either for a few days or a few weeks. Another interesting finding is that parents in the studies often "diagnosed" teething by the symptoms rather than by tooth appearance. Young babies' behavior can be very confusing. Babies also end up catching many minor illnesses during the months in which teeth typically appear. Parents, struggling to understand what is happening with their babies may decide that "teething" must be the reason for their babies' runny noses, skin rashes, and fevers but they are likely to be wrong. Each baby will experience teething in his or her own way but the research indicates that most of the symptoms related to tooth eruption are mild and short-term. We'll talk more next time about what parents might do to "treat" their babies' teething and whether or not these "treatments" work.

Next time: The Truth about Teething Part II: Can Parents Make Teething Easier for Babies?