Teething simplified

Ouch! It's hard to see your child in so much discomfort - sometimes it can be just as distressing for the parent as for the child. Usually, the first question we get is “what can we give our baby for teething?”  The short answer is that most teething remedies do not work and are even harmful. But there are many things we can do, which I’ll go through here. And when all else fails, the one treatment that does consistently help is ibuprofen (for infants 6 months and up), so we’ll talk about when that’s indicated. 

Our guide to teething:

• The tooth doula. If your baby sees how distressing this is for you, it can intensify their experience of pain, which increases your worry even more, and there’s that vicious cycle. Much like a partner or doula during childbirth, you can’t always take the pain away, but the last thing a mother would want to see during childbirth is a look of worry and distress on her partner’s or doula’s face. Rather, we support the one giving birth by providing reassurance, encouragement and confidence that this baby WILL come out, and you CAN do it! So let’s try that. Your baby is essentially giving birth to a tooth. Cheesy, I know, but bear with me. Give your baby confidence, let them know this pain is normal, that once they work through it, this will pass. Life is not without pain, so as your child experiences pain try not to focus on the fear of it happening, but demonstrating how we rise above it, how we support each other through it. That is what ultimately makes pain less painful and less scary going forward. This is not the only thing we’ll do of course, but it’s the most difficult and yet most important. Instead of you matching their frantic state, get them to match your calm state. Slow your movements, breathing and heart rate. Calm your voice. Look them in the eye with an empathetic gaze and smile lovingly. “Slow dance” with them, or walk with a slow, relaxed pace - you’re not running away from any threats, but meandering as if everything is as it should be.

• Specific comfort measures:

  • More upright posture reduces the blood pressure in the gums, thus reducing the pain/pressure from the swelling.

  • Distraction: go for walks, take a bath together, read to your baby - anything other than sitting there focusing on the pain.

  • Teethers: try a variety of non-toxic teethers* with different textures and consistencies to see what your baby likes.

  • Cold: try a teether in the fridge or washcloth in cold/ice water. But don’t do frozen: this can cause freeze burns to your baby’s cheeks.

• Save your money: most popular teething remedies such as amber necklaces, teething tablets, teething gel, etc., as well as many commercial plastic teethers, not only add no benefit, but they can cause harm*.

• If pain relief is really needed, ibuprofen is the safest and most effective choice for babies 6 months and up (acetaminophen for infants younger than 6 months). Because teething can last a long time in some cases, try to focus its use to the most uncomfortable moments such as night time when teething is disrupting sleep, and focusing on comfort measures during the day. When possible, limit these medications to no more than a week at a time.

• Sleep during teething: teething to be hugely disruptive to a child’s sleep. Whenever a child is in pain at night, it is always appropriate to comfort them. And as soon as that pain is gone, it’s best to go right back as soon as possible to the sleeping expectations you had for them before the teething began. For most families, this transition back goes fairly smoothly if they’re still tired from the recent sleep disruption, but not experiencing pain from the teeth anymore. However the longer you wait, the more difficult that transition will be as they build new sleep habits. If you’re not sure if your baby is experiencing pain or crying because they want your attention, sometimes a dose of ibuprofen can be helpful in this regard – it helps with the former but not the latter.

Signs to watch for

 

Call for an appointment IF:

Symptoms are severeThere are other signs of general illness such as fever (temp 100.4 or higher), lots of snot, cough, vomiting, baby looks sick, etc. Teething does not cause fever or any of these other symptoms, so if present there could be something else such as an ear infection causing your baby’s pain. You’re not sure it’s teething. Many other things can cause isolated irritability in babies that may require medical attention. If you’re not sure, especially if your baby is experiencing extreme discomfort, it’s never a bad idea to come in and have us look/confirm.A note on sores in the mouth/gums: Some things, such as an “eruption cyst“ can be normal. Other lesions like ulcers, blisters and various spots or bumps could be a sign of an infection. If you’re not sure, schedule an appointment so we can take a look.

 

Call urgently or go to the ER if:

infant less than 3 months with feverrespiratory distress (gasping for air, collapsing chest, rapid or shallow breathing)decreased responsivenesschild looks really ill to you (something not right)

*...but is there harm in trying a little (insert your neighbor's favorite remedy)? 

I really don’t like being an alarmist when it comes to caring for children, so I’m hiding these at the end only for parents who want more info, e.g. want to understand why I don’t advise these various remedies. Or, maybe you want to use them anyway, but want to know the risks. With that said, here are a few links with summaries of some of the issues we see: 

• Homeopathic teething tablets

• Amber necklaces

• Teething gel

• Chemicals in some teethers

• Frozen teethers: not advised. Can cause some teethers to become too hard and injure the gums, liquid teethers can crack and break, and anything frozen can cause cold panniculitis – a cheek burn that can last for weeks.

Same-day appointments

For urgent needs, same-day appointments are available Monday through Friday. Please call as early in the day as possible, the more notice we have the easier it is to fit everyone in. 

Need help outside of office hours?

Firstly, if your child has an emergency, please call 911 or go directly to the ER - they will contact us if needed once your child has been evaluated.

Urgent Care centers can also be helpful when something needs to be seen outside of office hours but it's not an emergency. 

For our list of preferred Urgent Cares and ERs, see our resources page.

And if you have something that might need urgent attention but you're not sure/don't know what to do, we can help: