Deborah Alford, PPCNP-BC, Texas Children’s Hospital

Imagine yourself as the parent of an adorable 4-month-old baby. You’ve successfully survived the first few months of this delightful new chapter of parenthood. Then, just as your bundle of joy is sleeping long hours, expressing himself with cooing and laughing and reaching out to your smiling face, he suddenly starts to drool and chew on everything within reach, resulting in interrupted sleep patterns from bouts of unexplained fussiness. These changes might be signs of teething in your baby. In these cases, knowledge is power; read on to discover some updated information related to helping your infant during this potentially challenging time of infancy.

What is teething?

Teething, the emergence of baby teeth beneath the gums, can begin as early as 3 months of age, but most babies start to teethe between 4-7 months of age. Common signs of teething may include:

  • Excessive drooling
  • Desire to chew on hands and most items brought to mouth
  • Red, swollen gums
  • Visible teeth appearing beneath the gums
  • Difficulty sleeping
  • Increased fussiness

What is not teething?

Teething is commonly blamed for many other infancy issues, including fever and diarrhea. However, parents should be aware that teething does not cause high fevers, vomiting, diarrhea, rashes, seizures, coughing or cold-like symptoms.

If your baby is fussy and has a fever over 101 degrees Fahrenheit, contact your baby’s health care provider for recommendations. Do not assume the cause is teething.

What are safe practices to soothe a teething infant?

In order to help your infant thrive during this time, consider these safe recommendations:

  • Offer teething rings made of firm rubber – not frozen, as these could harm the gums. One example is the Beckman Tri-Chew. Avoid teething rings containing liquids to avoid breakage and leaking.
  • Gently rub or massage your baby’s gums with your clean finger.
  • Offer a chilled washcloth. Avoid freezing this, as hard cloth could bruise the gums.
  • Talk with your baby’s health care provider for recommendations on using acetaminophen or ibuprofen if your baby seems irritable despite your best efforts.

What are unsafe teething relief practices every parent should know?

Unfortunately, some popular teething recommendations initially assumed to be safe have shifted due to developments in product research and safety standards.

Most recently, this includes using products containing the active ingredient benzocaine in infants and children. Benzocaine is a local anesthetic marketed to reduce a variety of painful conditions such as teething, sore throat and canker sores. Common brand name products containing benzocaine, including Anbesol®, Baby Orajel®, Cēpacol®, Cloraseptic® and Orabase®, are available for purchase in most U.S. drug stores and supermarkets, alongside several generic and store brand options.

In May 2018, the U.S. Food and Drug Administration (FDA) issued a warning against administering over-the-counter (OTC) teething products containing benzocaine to infants and children younger than 2 years of age. Benzocaine can lead to a potentially lethal condition called methemoglobinemia, which significantly reduces the amount of oxygen carried through the bloodstream. The FDA has since urged companies manufacturing these products to halt marketing them as teething pain relief for infants and children younger than 2.

The FDA has also recommended that consumers avoid using homeopathic teething tablets and gels with belladonna, which can pose a serious threat to infants and children. Belladonna, commonly known as deadly nightshade, is a plant with extremely toxic leaves and berries that has been used as both a poison and medicine throughout history.

When it comes to teething, parents should also consider these safety concerns:

  • Avoid tying a teething ring around a baby’s neck, or any other body part.
  • Avoid using teething necklaces made of amber due to strangulation and choking concerns.
  • Never rub aspirin or alcohol against the gums or teeth.

When those pearly white teeth finally erupt and your baby shows off his first toothy grin, every minute of parental angst over teething will be well worth it. Every stage of your precious bundle’s life will come with its own achievements and challenges.