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Signs & Symptoms of Teething
Chloe Rowe, M.D., discusses the signs and symptoms of teething. She answers the common questions that parents ask and offers great tips on how to best help your baby feel more comfortable while teething.
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Learn more about Chloe Rowe, MD
Chloe Rowe, MD
Chloe Rowe graduated from Dartmouth College and received her MD from Vanderbilt University School of Medicine in 2003. She completed her pediatric residency at Children's Memorial Hospital of Northwestern University in Chicago, IL. Prior to joining Weill Cornell Medical Associates in 2008, Dr. Rowe worked as a hospitalist pediatrician in neonatal intensive care and general pediatrics. She is a Fellow of the American Academy of Pediatrics.Learn more about Chloe Rowe, MD
Transcription:
Signs & Symptoms of Teething
Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast, featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. This is Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And today we're talking about teething. Joining me is Dr. Chloe Rowe. She's an Assistant Professor of Clinical Pediatrics at Weill Cornell Medicine and an Assistant Attending Pediatrician at New York Presbyterian Weill Cornell Medical Center. Dr. Rowe, it is a pleasure to have you join us again today. So, let's talk about teething. It's something that parents are concerned about. They think about it ahead of time, what's it going to be like. What age does it generally start?
Chloe Rowe, MD (Guest): Sure. Well, the symptoms of teething can start somewhere between the ages of four to seven months with the first tooth usually breaking through the gums between six and 12 months. Typically the first teeth that come in are our lower front teeth, which we call the lower central incisors and most children will usually have all of their baby teeth by age three. There is a very wide range of ages however, when the first tooth comes in. So, some babies have two teeth when they're four months old and others will still be toothless on their first birthday. So, I try to reassure parents that this wide range is very normal and not to worry, and also remind them that there is a genetic component to teething, meaning that late teethers can run in families.
Host: What a great point. Kids develop at different times. It's not all very cookie cutter. And I love that feeling of looking to see if that little teeth is erupted through the skin. It's really cute. So, symptoms, if parents aren't doing, as I did and keep checking the little baby's mouth to see if one's showing up. What are the symptoms? Are they always drooling? Is this painful for kids? Tell us about it.
Dr. Rowe: Teething can cause mild fussiness, sometimes changes in feeding patterns. For example, not wanting to chew as much or preferring smoother or cooler foods. And definitely most parents will note an increase in drooling. Parents may also notice that the gums around the new tooth may appear swollen or feel tender to the child.
Host: So there are a lot of myths, Dr. Rowe about teething. And we just talked about drooling. Cause that's something that definitely can signal it, but can it cause a fever? Can it cause diarrhea? Is there a time when we worry about teething?
Dr. Rowe: Well, the simple answer is no that teething does not cause a fever. A baby's body temperature may rise very slightly when teething, however, a true fever, which is what we described as 100.4 degrees or higher. A true fever is not associated with teething and may actually be a sign of illness or an infection that may require attention by a doctor. So, I would say if your baby is having fever, vomiting, diarrhea, cough, or runny nose, while they're teething, you should call your pediatrician for advice because those are not typical symptoms of teething.
Host: Does it sometimes become very painful to grow a tooth? It would seem as a parent that, yeah, it would kind of hurt, but as you said, for kids, it's mild mouth discomfort. Can it be extremely painful?
Dr. Rowe: It can be. I would say extreme pain, no, but many children will really have no problems at all when their teeth come in. And as you described, sometimes you're just looking and you're surprised that the child already has a tooth and they had no symptoms preceding the eruption of that tooth. But again, I think we can say it can cause mild fussiness, changes in feeding patterns and drooling, but irritability, extreme pain or discomfort or fever is typically not associated with teething.
Host: I'm so glad you cleared that up for parents. And I remember my son had no problem with it but my daughter did have that discomfort. So, let's talk about what we can do to help the kids that do have discomfort for those sore gums and teething. Are there certain remedies? Are we supposed to give Motrin or Tylenol? What can we do to help them through this?
Dr. Rowe: Sure. I like to stick with just very simple and basic things. So, one thing we can do to comfort our child while teething is massage. So, with clean hands and maybe a cold finger or a knuckle, we can gently massage the gums where the teeth may be coming through. We can offer them a teething toy, something rubbery, silicone that they can chew on and get some relief from those aching gums. One really simple remedy I recommend to parents is using a cold wet washcloth. So, getting a washcloth, running it under cold water, wringing it out, allowing the child just to kind of chew and gnaw on that washcloth. They can grip it really well. It feels cold, which is soothing. And the texture of the fabric is also soothing to the gums. I like to use medicines as my last resort. So, there may be a time when your baby's having a really rough day with teething, you can ask your pediatrician about giving an appropriate dose of acetaminophen or Tylenol.
Host: There are other myths and wives' tales about teething Dr. Rowe. So, I know my mother used to give little frozen mini bagels, you know, something to kind of chew on, but now there's like teething necklaces. Are there some remedies that are unproven, things you do not want parents to try and including the old one that a lot of our parents used to do is to dip their pinky in a little alcohol and rub that on the baby's gums.
Dr. Rowe: Yes. So, that's definitely a no-no today. We do not give alcohol to infants or to any children, so I would avoid any alcohol on the gums. I would also stay away from teething tablets. Often tablets will contain a plant poison called Belladonna and teething gels will contain an ingredient called benzocaine and both Belladonna and benzocaine are marketed to numb the child's pain.
However, there have been multiple warnings against these products due to potential side effects. So, I would avoid Belladonna and benzocaine. And then I'd say the Amber teething necklaces are a really big no. The main concerns with those are strangulation and choking. And probably I need to say no more, but there's also no research to support the effectiveness of these necklaces. And of course, placing a necklace around an infant's neck is a very major concern for strangulation risk or choking hazard.
Host: Before we wrap up, I'd like you to give us your best advice and summary about teething for parents, but when you feel it's important that they call their pediatrician, if they have concerns, because you know, it's kind of an up and down time for parents. They're not sure if the baby waking in the night and all of those things are related. They're not sure if they should be giving pacifiers or not. Kind of wrap it all up for us with your best advice and when you want us to call our pediatrician,
Dr. Rowe: Well, I think one important bit of information to remember is teething does not cause a fever. So, if your baby is feverish or having symptoms of illness, I would not assume it to be teething and I would call the doctor. I'd also remind parents to be patient, you know, teething, as we discussed can last anywhere from about six months to three years old. So, that's a very long time. So, be patient. Don't overuse things like Tylenol and other medications and the last reminder would be, not to use those unsafe remedies or those products that have no evidence to support their effectiveness for teething like those Amber teething necklaces or the tablets or gels that can contain unsafe ingredients.
Host: It's great information. And, you know, it's great to reinforce this for parents, that this is a normal thing that babies go through and contact your pediatrician if you have any questions about when your baby is teething. Thank you so much, Dr. Rowe. You are a great guest as always, and Weill Cornell Medicine continues to see our patients in-person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to thank our listeners and invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcasts, Spotify and Google Podcasts. For more health tips, go to WeillCornell .org and search podcasts. And don't forget to check out Back to Health. I'm Melanie Cole.
Signs & Symptoms of Teething
Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast, featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. This is Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And today we're talking about teething. Joining me is Dr. Chloe Rowe. She's an Assistant Professor of Clinical Pediatrics at Weill Cornell Medicine and an Assistant Attending Pediatrician at New York Presbyterian Weill Cornell Medical Center. Dr. Rowe, it is a pleasure to have you join us again today. So, let's talk about teething. It's something that parents are concerned about. They think about it ahead of time, what's it going to be like. What age does it generally start?
Chloe Rowe, MD (Guest): Sure. Well, the symptoms of teething can start somewhere between the ages of four to seven months with the first tooth usually breaking through the gums between six and 12 months. Typically the first teeth that come in are our lower front teeth, which we call the lower central incisors and most children will usually have all of their baby teeth by age three. There is a very wide range of ages however, when the first tooth comes in. So, some babies have two teeth when they're four months old and others will still be toothless on their first birthday. So, I try to reassure parents that this wide range is very normal and not to worry, and also remind them that there is a genetic component to teething, meaning that late teethers can run in families.
Host: What a great point. Kids develop at different times. It's not all very cookie cutter. And I love that feeling of looking to see if that little teeth is erupted through the skin. It's really cute. So, symptoms, if parents aren't doing, as I did and keep checking the little baby's mouth to see if one's showing up. What are the symptoms? Are they always drooling? Is this painful for kids? Tell us about it.
Dr. Rowe: Teething can cause mild fussiness, sometimes changes in feeding patterns. For example, not wanting to chew as much or preferring smoother or cooler foods. And definitely most parents will note an increase in drooling. Parents may also notice that the gums around the new tooth may appear swollen or feel tender to the child.
Host: So there are a lot of myths, Dr. Rowe about teething. And we just talked about drooling. Cause that's something that definitely can signal it, but can it cause a fever? Can it cause diarrhea? Is there a time when we worry about teething?
Dr. Rowe: Well, the simple answer is no that teething does not cause a fever. A baby's body temperature may rise very slightly when teething, however, a true fever, which is what we described as 100.4 degrees or higher. A true fever is not associated with teething and may actually be a sign of illness or an infection that may require attention by a doctor. So, I would say if your baby is having fever, vomiting, diarrhea, cough, or runny nose, while they're teething, you should call your pediatrician for advice because those are not typical symptoms of teething.
Host: Does it sometimes become very painful to grow a tooth? It would seem as a parent that, yeah, it would kind of hurt, but as you said, for kids, it's mild mouth discomfort. Can it be extremely painful?
Dr. Rowe: It can be. I would say extreme pain, no, but many children will really have no problems at all when their teeth come in. And as you described, sometimes you're just looking and you're surprised that the child already has a tooth and they had no symptoms preceding the eruption of that tooth. But again, I think we can say it can cause mild fussiness, changes in feeding patterns and drooling, but irritability, extreme pain or discomfort or fever is typically not associated with teething.
Host: I'm so glad you cleared that up for parents. And I remember my son had no problem with it but my daughter did have that discomfort. So, let's talk about what we can do to help the kids that do have discomfort for those sore gums and teething. Are there certain remedies? Are we supposed to give Motrin or Tylenol? What can we do to help them through this?
Dr. Rowe: Sure. I like to stick with just very simple and basic things. So, one thing we can do to comfort our child while teething is massage. So, with clean hands and maybe a cold finger or a knuckle, we can gently massage the gums where the teeth may be coming through. We can offer them a teething toy, something rubbery, silicone that they can chew on and get some relief from those aching gums. One really simple remedy I recommend to parents is using a cold wet washcloth. So, getting a washcloth, running it under cold water, wringing it out, allowing the child just to kind of chew and gnaw on that washcloth. They can grip it really well. It feels cold, which is soothing. And the texture of the fabric is also soothing to the gums. I like to use medicines as my last resort. So, there may be a time when your baby's having a really rough day with teething, you can ask your pediatrician about giving an appropriate dose of acetaminophen or Tylenol.
Host: There are other myths and wives' tales about teething Dr. Rowe. So, I know my mother used to give little frozen mini bagels, you know, something to kind of chew on, but now there's like teething necklaces. Are there some remedies that are unproven, things you do not want parents to try and including the old one that a lot of our parents used to do is to dip their pinky in a little alcohol and rub that on the baby's gums.
Dr. Rowe: Yes. So, that's definitely a no-no today. We do not give alcohol to infants or to any children, so I would avoid any alcohol on the gums. I would also stay away from teething tablets. Often tablets will contain a plant poison called Belladonna and teething gels will contain an ingredient called benzocaine and both Belladonna and benzocaine are marketed to numb the child's pain.
However, there have been multiple warnings against these products due to potential side effects. So, I would avoid Belladonna and benzocaine. And then I'd say the Amber teething necklaces are a really big no. The main concerns with those are strangulation and choking. And probably I need to say no more, but there's also no research to support the effectiveness of these necklaces. And of course, placing a necklace around an infant's neck is a very major concern for strangulation risk or choking hazard.
Host: Before we wrap up, I'd like you to give us your best advice and summary about teething for parents, but when you feel it's important that they call their pediatrician, if they have concerns, because you know, it's kind of an up and down time for parents. They're not sure if the baby waking in the night and all of those things are related. They're not sure if they should be giving pacifiers or not. Kind of wrap it all up for us with your best advice and when you want us to call our pediatrician,
Dr. Rowe: Well, I think one important bit of information to remember is teething does not cause a fever. So, if your baby is feverish or having symptoms of illness, I would not assume it to be teething and I would call the doctor. I'd also remind parents to be patient, you know, teething, as we discussed can last anywhere from about six months to three years old. So, that's a very long time. So, be patient. Don't overuse things like Tylenol and other medications and the last reminder would be, not to use those unsafe remedies or those products that have no evidence to support their effectiveness for teething like those Amber teething necklaces or the tablets or gels that can contain unsafe ingredients.
Host: It's great information. And, you know, it's great to reinforce this for parents, that this is a normal thing that babies go through and contact your pediatrician if you have any questions about when your baby is teething. Thank you so much, Dr. Rowe. You are a great guest as always, and Weill Cornell Medicine continues to see our patients in-person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to thank our listeners and invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcasts, Spotify and Google Podcasts. For more health tips, go to WeillCornell .org and search podcasts. And don't forget to check out Back to Health. I'm Melanie Cole.