Luke Voytas is a pediatrician and author in Portland, Oregon. His posts combine research and common sense to help parents be calm and confident in raising their kids.

Teething - tormenting parents for over 2000 years!

Teething - tormenting parents for over 2000 years!

The mystique and myths surrounding teething are rivaled only by the sasquatch, or maybe alien abductions. Many kids will get their first teeth, usually the bottom two middle ones, between six and seven months. From there it’s a chaotic, erratic explosion of progressively larger dentition until after two years old.

Not to be dramatic, but teething comes like a shadow in the night – no one really knows when it’s coming or what it looks like, but it terrorizes entire villages and leaves only a trail of sleepless devastation. Was that too dramatic? Teething will get inside your head, that’s for sure. Every time your baby is fussy, every time she wakes up in the middle of the night for no obvious reason, you’re going to ask, “Is it teething?” Every time she has a runny nose or red cheeks, you’re going to be feeling those gums and swearing that you feel bumps. Parents blame everything on teething! So we need to demystify it a little bit. Let’s start with some amusing folklore and take the long arc to science.

As long as there have been babies, teething has been a convenient scapegoat. As recently as one or two centuries ago, a lot of infants and toddlers died from a variety of causes. Doctors usually didn’t know why, but they knew that teething could make kids miserable. So it was natural to blame a lot of the deaths on teething.

And when you think something can kill a kid, you’re more willing to try some pretty crazy stuff to try to prevent it.

The trail of teething remedies starts in ancient Greece, where a famous doctor named Soranus recommended rubbing mushed up hare brains on the gums. He didn’t give specifics on catching the hare and accessing its brain.

During the middle ages, doctors would treat teething by blistering the gums, putting leeches on the gums, and even doing some “gentle” cauterization on the back of the head (ouch). In the 1500s, a French surgeon theorized that many babies died when teeth tried to erupt but didn’t have a pathway. (1) He introduced the practice of “lancing” or cutting the gums to free up the teeth, which was practiced widely for the next 300 years. Obviously, this wasn’t always done with the most sterile of techniques.

One crusty pediatrician got fed up with the madness in 1861 and wrote, “I can assure you that the readiness to attribute all the diseases of infantile life to teething has destroyed more human beings than many of the wars described in history.” (2)

There wasn’t much regulation of medicines in the 1800s, and teething quackery became big business. You can see an ad for the trusted “Cocaine Toothache Drops” above. One of the most popular products was “Mrs. Winslow’s Soothing Syrup,” which promised desperate parents that “it will give rest to yourselves, and relief and health to your babies.” (3) In reality, little old Mrs. Winslow was slinging a cocktail of morphine and alcohol! I don’t doubt that everyone got better rest, but, uh. . . .yeah.

Even during the first half of the twentieth century, many teething “powders” contained a form of mercury called calomel. (4) Which was likely not good.

This crazy stuff is all pretty interesting. But what does teething do to kids? And what can we do to help them, if not cocaine and morphine?

A 2000 study in Pediatrics followed 125 healthy children from four months old to twelve months old. (5) Parents recorded multiple temperatures and the presence or absence of eighteen different symptoms every day. They also recorded every tooth eruption so the symptoms could be correlated. They found that the following symptoms were associated with teething:

  • increased biting and drooling

  • gum rubbing and sucking

  • irritability and wakefulness

  • ear rubbing

  • facial rash

  • decreased appetite for solid foods

The symptoms were not very strong. None of them occurred in more than thirty-five percent of teething infants. Teething did not seem to cause the following:

  • very loose stools

  • significant congestion

  • severe sleep disturbances

  • fevers over 102 degrees

  • rashes

So if your baby has a cough and congestion, it’s more likely a cold. If she goes from having one normal poop per day to three or four watery ones, it’s probably a stomach virus. And, as frustrating as this is, sometimes babies are just fussy, or they go through a rough few days of poor sleep for no particular reason. Conversely, if your baby is fussy and pulling at her ears but doesn’t have any congestion, it’s likely to be teething and not an ear infection.

Let’s focus on the fussiness that we know teething can cause. What can we do to help?

1. Cold chewy things – These are the mainstay, safe and effective. You can buy a wide variety of hard rubber rings to chew on. Some of these have liquid inside so that you can put them in the freezer or refrigerator to get them cold. Someone will probably buy you one of those fancy French Sofie giraffes, which is kind of expensive for a dog toy but, hey, it’s French. Two of my secret weapons are things you already have at home. Wet a few small washcloths and put them in small ziplock bags in the freezer. Or slice a bagel in half the long way and freeze it the same way. You can pull these out when needed and your baby can go to town on them – the cold and the consistency are a double whammy of relief for swollen gums.

2. Acetaminophen (Tylenol) or Ibuprofen (Motrin/Advil) – You really want to use these as little as possible for teething. I think they have a role to play, but a small one. Avoid using them during the day, because the cold chew toys work well. If you can see that your baby has swollen gums and she is really having a hard time getting to sleep at night because of the pain, I think it’s reasonable to use either one for up to 2 or 3 nights while things are at their worst. Remember that ibuprofen can be used only after your baby turns six months old.

Which treatments should you avoid?

1. Natural teething tablets – Stay away from these. To many people “natural” or “homeopathic” means safe. To pediatricians those words can mean untested and unregulated. There has never been any evidence that these work. Furthermore, there was a scary recall in 2010 for one of the most popular brands. They were designed to contain a small amount of belladonna, a natural compound that is dangerous in certain amounts. But the tablets had very different amounts of belladonna, and there were reports of children suffering seizures due to the tablets. There was another recall in 2017 for the same reason.

2. Baby teething gels (e.g. Orajel) – Also not great. They do work but only last for a short time. The medicated versions contain benzocaine, a numbing medicine known to pose a risk of methemoglobinemia, a nasty condition where your blood can’t carry as much oxygen as it normally does. Due to this concern, the manufacturers write “recommended for two years and up” in small print on the back of the box. On the front of the box is an infant who looks like he’s sleeping soundly after getting Orajel. And they recommend using a pea-sized amount up to four times a day. That’s a LOT, resulting of course in you buying more. There are also lots of “natural gels” available as well that are untested and unproven.

3. Amber teething necklaces – These are super popular right now – I see them every day. But there are two major issues with amber necklaces. First, they’re not safe. There have been multiple choking accidents from the beads and one 18 month-old even died after getting strangled by the necklace during a nap. The FDA was concerned enough that they issued an official warning about the necklaces in December 2018. The second issue is that they don’t work. At all. There are a lot of purported mechanisms for the amber’s effect, such as magnetism or an aura of healing energy. The most rational explanation is that the amber contains succinic acid, which is known to have some anti-inflammatory properties. But that compound is only released above 180 degrees, which even a raging fever won’t get close too. And even if it   work, would you want a chemical leaching continuously into your child’s bloodstream?

So there you have it. You’re not the first parent to be bewildered by teething. And even if you tried a treatment from the “naughty list,” you can feel good that you did not give your baby cocaine. And if I see you in the office with a kid who is fussy and sleeping terribly for no reason, I apologize ahead of time that I don’t know what to tell you.

Maybe it’s teething.

1. Dally, Ann. "The lancet and the gum-lancet: 400 years of teething babies". The Lancet. 1996; 348(9043): 1710–1.

2. The retrospect of practical medicine and surgery, W. Braithwaite and J. Braithwaite, eds. 1861. New York. W.A. Townsend and Co. Part 42.

3. Day, Nicholas. “Morphine, wolf’s teeth, hare brains? The endless quest to solve teething.” Article on, April 17, 2013.

4. Dally, Ann. "The Rise and Fall of Pink Disease". Social History of Medicine. 1997;10(2): 291–304.

5. Macknin et al. “Symptoms associated with infant teething: a prospective study.” Pediatrics. 2000; 105(4): 747-752.

On Quitting Hitting: why it's time to stop spanking our kids

On Quitting Hitting: why it's time to stop spanking our kids