sWell

(random riffs on topics medical)

rahul k. parikh

rahul k. parikh
Location
Walnut Creek, California,
Bio
Physician & Writer www.rahulkparikh.com www.twitter.com/docrkp The information here is not direct medical advice.

Editor’s Pick
FEBRUARY 25, 2009 8:20PM

The Truthiness About Teething

Rate: 15 Flag

tooth

 

If you were a baby in 19th Century England you may have been better off without teeth. 

That's because according to government records, it turns out that 5% of kids died as a result of teething.  While that's not an public health crisis, it's not trivial either.

 Now consider that for the past, say, 110 years, zero children have died from teething.  

Teething. Cured.  How?  Are Oragel and teething rings the great public health breakthrough ever?The unsung saviors of infants everywhere?  

How many of you have taken your child to the doctor with some vague symptoms--fussiness, drooling, rashes, diarrhea, sleep disturbances etc, etc, etc, and told it was teething by your mother-in-law, crazy uncle, or worse, your...doctor.    

Indeed, studies have shown that parents, dentists and doctors are all quick to believe in teething.  So ingrained are doctor's  notions of teething we even have an official, billable, diagnosis for it:  "Teething Syndrome" (icd-9 code 520.7 for you Jeopardy fans). 

Let's back up a second:  What's the evidence for a "teething syndrome?"  Over the years, studies have been done trying to sort this out.  One study from 2000 looked at a little over 400 kids and whether they had teething symptoms.   No of the observed symptoms reliably predicted teething, and the researchers wisely concluded:  "Before caregivers attribute any infants' signs or symptoms of a potentially serious illness to teething, other possible causes must be ruled out."

That' s been the overall trend with teething studies--fact and fiction are very different, yet we continue to  believe in it.  Why?

Well, if you're someone like me (a health professional), it's an out when you have no idea about what's going on with a kid, or you're patient's parents are "worried well" meaning they come in for minor, insignificant symptoms a lot, and need reassurance that their child is healthy.   

  I'll venture a guess at some of the things that we attribute to teething, but are really due to something entirely different:

1) Sleep disturbances:  according to sleep experts, kids don't wake up in the middle of the night from teeth coming in--no, they wake up from spontaneously awakening as they shift from one stage of sleep to the next (ie, REM to non-REM sleep). 

2) Drooling:  one reason I've observed kids seem to drool is that around 4 to 6 months, they get better control of their neck muscles, which allows them to hold their head up better.  On the other hand, they don't get the same control over their salivary secretions--hence, it comes out front instead of heading down the back of their throats. 

3) Rashes around the mouth:  Saliva, described above,  hits the skin and irriatates it a little. 

4) Fussiness: If you're kid isn't fussy, then call Yoda, because he or she must be a future Jedi Knight. 

Ok, then so what's the big deal?  Most of the time, the symptoms we attribute to teething are pretty harmless.  The solutions--whether it be teething rings, oragel, cold soda cans, teething tablets or other the "prescriptions" for teething, are also generally harmless (who knows how much money makers of these remedies make per year on these solutions). 

(On the other hand, some choices for teething are probably best avoided: take in point the recent deaths of 84 children in Nigeria from contaminated teething medicine.)

I hate teething as a diagnosis or an excuse.  I don't use it.  The biggest deal for me, and I tell this to parents in my own practice, is when they're told that teething causes fever.  No, I don't mean a slight, normal elevation in a baby's temperature to say, 99 degrees.  I mean a fever that's over 100.4 degrees (that's the definition of a "true fever" among physicians).  Fever of any kind is generally due an infection, and needs to be approached by you, your mother-in-law, your crazy uncle and most importantly, your doctor, as such.  While in most healthy, vaccinated kids, fever is usually due to a temporary viral infection, it could be a harbinger of something more serious. 

That's not meant to scare you, just to inform you that you ought to fire your mother-in-law, crazy uncle, or doctor if they blow your baby's temperature off due to teething. 

And that's the Truthiness about Teething.

 _____________________________________________

www.rahulkparikh.com

http://twitter.com/docrkp

Your tags:

TIP:

Enter the amount, and click "Tip" to submit!
Recipient's email address:
Personal message (optional):

Your email address:

Comments

Type your comment below:
Preach on! I hate this teething causes everything under the sun (and you forgot diarrhea) belief system. So when are you going to tackle my other pet peeve: growing pains?
teendoc,
I'll let you take on growing pains!
thanks,
Interesting. I get the point about debunking things that are wrongly attibuted to teething but don't you think there is some pain an discomfort from actual teething?
I remember my adult teeth coming in and it hurt like crazy. don't you think the same happens for infants and toddlers getting their baby teeth?
And I had horrible growing pains- at around five or six, I would go through periods of days where my bones would ache so much it kept me from sleeping. Maybe that was some kind of infection or something that was not treated?
I'm going to disagree with you. I understand the scientific studies and so on, but I have a child. Definitely, her mouth hurts. You can watch her put her little hands to the sides of her face, cry when she bites down in the wrong area--that swollen part of the gum. This pain makes her restless at night. Of course, she doesn't slip easily from sleep stage to sleep stage. It hurts! Even if I give her something, as soon as we hit the time limit for it to wear off, she'll start tossing and turning and moaning.

I'm sure not every little thing is caused by teething, but restlessness in sleep? Yep. However, if you disagree, I tell you what ... I'll let you come babysit when her next set of molars come in. You can get up with her all night long. I'll be snoozing comfortably in the hotel down the street. ;)
Celia,
good questions-I have no idea about whether your experiences are something others shart around adult teeth coming in.

on the subject of bone pain, if you had an untreated infection, it wouldn't have gone away by itself--bone infections are pretty serious, and certainly need medical attention
I'm with the other parents. I think both teething and growing pains are real. Now whether teething causes fever, diarrhea, or death is highly questionable. It may manifest itself differently in different babies (or even in the same baby), but that doesn't make it any less real. In general, pain is a very tricky and shifty thing, and I can sort of understand why you white-gown doctors are so uncomfortable with pain in general.
I love the old-timers' cure for teething pains though: rubbing brandy on the babies' gums! I was so tempted to do that to my boy one night... but my wife refused to hear of it.
Odette,
thanks--could be some feel it and other don't. regardless, and like I said, if you think your daughter's got it, then most otc teething remedies are safe.
icemilk,
oh yeah-I forgot brandy-helps put teething grownups to sleep better, too.
I forget what my daughter's symptoms were, but the baby book (Penelope Leach, and generally good) said before X months the symptoms (exactly what daughter had) can't be teething. Two days later, she cut her first tooth, making me believe in the teething symptoms.
Every child is different. Glad you're such a pro.