Teething troubles for babies and how parents can help

Teething, when mentioned to any adult it is likely to be met with a negative response centered on a miserable baby. They don’t even need to be parents but they certainly have heard of the sleepless nights and the crying associated with a little one cutting teeth. In my own house teething was certainly not a happy time. Interrupted rest, irritability and endless drool was part of the picture. Perhaps it was just my training ground for knowing exactly what a lot of parents go through when their babies are teething.

Having said this, I have known parents to report waking up to a happy baby who grins at them with a little white pearl in place of the gummy smile. It does happen believe it or not.

Since babies have been getting teeth for as long as humans have been on earth, the old wives tales and remedies for teething are endless. For first time parents this can be extremely confusing. I recall being at the country club in Port Shepstone for Christmas lunch. My son was six months old and was not happy. I have no doubt that the other guests were even less impressed by having a fussy baby in the room. One elderly lady lent over and suggested we rub his gums with brandy! At that point I imagine the brandy would have done me more good than it would have the baby. Needless to say we opted to go home early and leave the good folk to their Christmas lunch rather than make use of the brandy advice.

Rule number one is not to listen to endless people giving advice. Keep it simple and know for certain it will end.

When do babies start teething?

In general babies start cutting teeth around the age of 6 months. This is general though as there are some babies who are in fact born with teeth and others who may get teeth as late as 12 to 18 months.

If we stick to what is general then you will probably notice that your baby starts drooling more and biting on objects from around 4 months of age. This is due to the fact that the teeth start pushing up from the bone where they are formed while baby is still in the womb. It is a process and one that continues for some time until the teeth actually pop through the gum itself. The second molars generally appear around the age of two and a half years of age. As a rule most children will have all 20 of their milk teeth by the time they are 3 years old.

How will I know if my baby is teething?

Looking at the literature it is safe to say that the most common signs of teething are:

1. Drooling. Teething stimulates drooling so this is certainly something which increases when a baby starts to teeth. The drooling may cause baby to develop a chin rash so it may be a good idea to make use of a little, soft cloth to dab the chin dry from time to time. The extra saliva may also cause baby to cough or gag as she or he gets used to having so much extra to swallow.
2. Irritability and poor sleep. As the teeth push through the gums babies may experience pain. This is particularly true with the first pair of teeth, canines and the molars. In the early stage the gums are quite hard and baby hasn’t got used to the pain associated with teething. Since molars are a lot bigger they will cause more pain than the smaller front teeth. This pain is usually at its worst for about three days.
3. Biting on objects. During the teething process your baby will bite on almost anything. The pressure of biting down relieves the pressure in the gums and helps the tooth to break through the gum.
4. Swollen, red gums. This is really just a bit of inflammation of the gum as the teeth start pushing through.

What is not a symptom of teething?

Here it all gets a little controversial and some parents would argue that “when my child is teething….”. I have been through a lot of literature, including the articles published in the American Journal of Paediatrics, and drawing on my own experience as a paediatrician there are certainly symptoms which should not be attributed to simply teething.

1. High fever: A temperature higher than 38⁰C should not be ignored and only attributed to teething. The research shows that babies may have a warmer feel to their bodies while teething but a temperature in excess of 38⁰C is indicative of infection. Remember babies of this age are exploring and certainly putting all sorts into their mouths. Germs are easily picked up this way. A fever which persists for longer than 2 days should be investigated.
2. Sore ears and a reluctance to lie down: When the molars are pushing through babies may pull their ears because of referred pain. If pulling on the ears is coupled with a lot of crying and reluctance to lie down one needs to consider that baby may have an ear infection. The extra saliva and mucus produced at this time may also put pressure on the ear drum and this can also cause discomfort.
3. Vomiting and Diarrhoea: Since babies are swallowing a lot of mucus when teething the stools may be softer but baby should not experience diarrhoea. If baby is suffering from diarrhoea then ensure that he or she is well hydrated with clear fluids and keep baby on a bland diet. On my website I have provided information on how to deal with vomiting and diarrhoea. If the diarrhoea persists or if you are concerned about dehydration you must consult your healthcare practitioner.

What can I do to help my baby during the teething process?

None of us like to watch our children in pain so we would like to offer some kind of relief. There are a few things one can do:

1. Give baby a chilled (not frozen) teething ring to bite on. This will numb the gums slightly and provide the baby with something to bite on. Please ensure that you sterilize the ring regularly. Ensure that the ring is made from a tested baby product.
2. A damp chilled burp cloth. By simply wetting the cloth, wringing out the excess water and popping it into the fridge, you will have another item for baby to chew on.
3. If the pain is extreme you may give your baby some paracetamol. Be sure to check the dosage on the bottle or to ask your healthcare professional for advice. You are also welcome to visit my website for a guide to correct doses.
4. Amber bead necklace. There are parents who swear by the beads but the current literature warns against chocking if the baby has a necklace on. Also if the necklace were to break your baby may be tempted to pop a bead into its mouth. This may also lead to choking. Those in favour of the amber bead necklaces explain that the Succinic Acid released by the beads is absorbed as a natural analgesic. The beads themselves are not designed for baby to chew on so caution should be taken if you are opting to try them.
5. Do NOT use teething gels. The American Academy of Paediatrics does not recommend putting any gels on a babies gums. Some of these products contain lidocaine and this is extremely dangerous if swallowed in large amounts. Lidocaine is a product specifically designed to numb certain areas of tissue. Remember baby is drooling a lot so gel does not stay on the gums which is the area which you may be wanting to numb. Instead, if a product that is intended to numb the gums is swallowed, it can numb the back of the throat and inhibit swallowing. Babies who are finding it difficult to swallow are likely to choke. There are also other serious side effects, including seizures, brain injury and heart complications associated with the ingestion of large amounts of lidocaine.

Teething patterns

Although certain children will cut teeth in a different order, we generally find that the two little bottom teeth appear first. My daughter cut her teeth in what we were told was a “cross cutting pattern”. First one of her bottom teeth cut followed by the opposite top tooth. It did look quite odd and she certainly loved the sound of grinding one against the other. Milk teeth do seem to make a much louder sound when being ground together, something which sends shivers up my spine. Our dentist, however, assured us that children often do this as they get used to having a new asset in their bodies.

You can usually expect the following:

• Two central bottom teeth (central incisors) at around 6 months
• Two central upper teeth (upper central incisors) around 8 months
• Two lower and upper lateral incisors ( ie next to the central teeth) around 10 months
• The first molars appear around the age of 14 months
• The canines or eyeteeth around 18 months
• And finally the second molars around 24 months

Baby has a tooth, what now?

It is recommended that you wipe your baby’s gums with a clean damp cloth or gauze, even before any teeth arrive. I like the idea of gauze, since you can buy a block of gauze squares that you can use once and then discard. When baby has just a few teeth continue with the clean damp cloth or gauze.

From here you should progress to a little finger toothbrush before moving onto a soft tooth brush. Teeth cleaning should always be supervised to make sure that these precious items are well cared for and last right up until it is time for adult teeth. It is essential that babies get used to having their teeth cleaned from a young age to avoid them finding the process unpleasant later.

In conclusion:

Teething is a very natural process and the experience is different for all children and their parents. My advice is to try and use all the natural means of soothing your baby like the chilled teething ring, cool cloth and so on before resorting to medicines. It is a process that will continue for at least two and a half years but as your baby gets older the experience won’t be as bad as it is in the beginning. If any symptoms other than the drooling, red gums and irritability occur you should consider that baby may be ill from some other cause. Taking care of these little jewels is vitally important for your child’s future health so ensure cleaning them becomes part of the daily routine.