How to manage teething
Tot expert, Dr. Clare Thompson, shares her tips on soothing sore little gums.
Just when you thought you’d made huge progress with your baby and managed to establish some sort of reasonable sleeping routine, their first tooth makes an appearance and you find yourself right back to square-one, waking up with them through the night to comfort and soothe them.
When your baby’s first tooth arrives it is both exciting and frustrating as your child may suddenly become more irritated from discomfort, drool excessively and wake during the night with sore gums and rashes around their mouth.
A baby’s first teeth (milk teeth) actually develop whilst the child is growing in the womb. Every baby experiences teething slightly differently but in most babies the milk teeth start to emerge through the gums when they are around 6-7 months old. However, there is a spectrum of normal with some babies showing their first tooth emerging as early as 3 months old and others not teething until after their first birthday.
Pattern of tooth growth
The most common milk teeth to appear first are the two front teeth in the lower gums, followed by the two front teeth in the upper gums. Then the pattern goes outward with lateral incisors, which are the next spot over, followed by the molars closest to the opening of the baby’s mouth. Finally the canines appear on either side of the lateral incisors and the last are the second molars in the very back of the gums. The American Dental Association Tooth Eruption Chart illustrates this nicely.
Teething symptoms can precede the actual appearance of the tooth by as much as 2-3 months. Your little one clearly won’t understand why they are waking in the middle of the night with achy gums or why the skin around their mouth is so itchy but here are the top teething symptoms to be on the lookout for with practical tips on how to manage them.
Teething stimulates your baby’s mouth to produce more saliva and results in excessive drooling. If you notice that your little one’s clothes are often soggy with saliva, try placing a simple bib to gently wipe their chin throughout the day to keep them more comfortable.
Pressure from the new teeth emerging through the gums causes the baby to be in a lot of discomfort. Biting a cooled teething ring is a good way to relieve the discomfort and offer some counter-pressure on the gums.
Crying, irritability and waking at night
Some lucky babies sail through the teething process with little disruption in their sleep whilst others struggle with a significant amount of pain which wakes your little one up periodically through the night and makes them more unsettled during the daytime. The pain is due to inflammation of the tender gum tissue as the tooth pushes through to emerge at the gum line. It is much like when you or I have dental pain and are unable to think of anything else, your baby will cry and be grisly when they are in pain from their new teeth. This may result in irritability for a few hours to a few days. Once you have exhausted all natural pain remedies, a simple acetaminophen (Tylenol) for children is a useful and sensible way to soothe your baby periodically. Do not use over the recommended doses on the box and do not mix it with other pain killing agents.
Ear pulling and cheek rubbing
The gums, cheeks and ears share nerve pathways and so an ache in the gums can travel and be felt in the structures nearby. As such some babies may tug at their ears or chin when teething. A baby tugging at their ears could also be a sign of an ear infection so make sure you consult your Paediatrician to exclude this first.
Refusal to feed
The suction of nursing may irritate the gums of a teething baby which will make it sore for them to latch on and feed. Teething babies will tend to be quite fussy about feeding and be frustrated as they are also hungry at the same time. Babies who are already on solids when teething may refuse food for a few days at a time. It is important to maintain hydration when food is refused and if this pattern continues for more than a few days then it is best to see your Paediatrician to assess their hydration status.
Teething rash around mouth
Teething stimulates your baby to produce more saliva and drool. The excess saliva produced can cause chafing, chapping and redness to the skin around their mouth and neck. Using a protective bib can be helpful as a barrier and also to gently wipe their mouth. Barrier products such as organic nipple cream or Coconut oil can also be used to form a protective moisture barrier and soothe chapped skin around the mouth.
The excessive drool will also be swallowed by your baby and this may cause them to cough and gag. Try to keep them upright during the daytime where possible to prevent positional gagging.
A lot of mothers tell me that their baby has looser stools when they are teething, possibly related to poor feeding of solids and also swallowing excessive saliva during this time. The saliva is more acidic when a baby is teething to help the new teeth to emerge through the gums and this acidity can also affect the gut and cause the stool to be looser. If the loose stool lasts for more than a few days at a time then highlight this with your Paediatrician to exclude signs of dehydration and other underlying causes.
Many mothers report that their baby often has a low-grade fever when teething which is due to the immune systems response to inflammation in the gums. Any fever greater than 101 should be escalated to your Paediatrician.
IMPORTANT: Teething does not cause high fevers and you should see your Paediatrician if your baby presents with a raised temperature over 101 to exclude other underlying causes.
Mothers complain to me about the vicious cycle of teething pain and then the baby refusing their food and drink which leaves them hungry and even more irritable. So what really works?
Cooled teething rings and teething toys can provide some counter pressure to your baby’s gums which will be soothing. You can place these teething rings in the fridge to ensure that they are the optimal temperature for your baby.
Chewing is another way of providing counter pressure on the gums and can relieve some of the discomfort the baby is experiencing as the teeth push through the gum lines. As mentioned above, specially designed teething rings are available which can be placed in the fridge to give some instant relief to your little one. Be sure not to put the teething rings in the freezer as very cold temperatures can also hurt sensitive gums.
Cold drinks and food
Icy food to suck on and chilled food to eat and drink can provide numbing properties to help soothe the baby’s inflamed gums. Frozen, mushed-up fruits with the chunks removed can be soothing and appetizing as is cold yoghurt. Using a mesh-feeder you can safely get rid of any chunks in foods and give your baby nutritional, cool foods to eat whilst teething.
Frozen wet washcloth
Using a wetted clean, soft washcloth which has been in the fridge can provide simple and fast relief when applied to your baby’s gums.
If you have tried all of the natural remedies to no avail, as an absolute last resort using some children’s Tylenol can be sensible and appropriate short term. Try not to use more than the recommended doses for your baby and do not to mix with other pain relieving agents.
Using thoroughly washed hands you can also try gently massaging the baby’s gums as counter pressure, but just be prepared for a little nibble.
Extra cuddles and patience are especially helpful to comfort your baby until the tooth has finally come through.
Ultimately the key here is to temporarily soothe your baby’s gums so that you can help them to eat and drink whilst the teeth are coming through.
What to avoid
Teething gels and numbing agents
While teething gels were once considered an acceptable method to help soothe teething pain, due to safety concerns their use is now discouraged. The main ingredient in most teething gels is benzocaine which is an anesthetic that the Food and Drug Agency (FDA) have reported can cause a rare condition called Methemoglobinemia, a condition in which oxygen carried in the bloodstream is reduced to dangerous levels. These gels only have very temporary effects either way and wash away from the gum line within minutes. For these reasons the FDA issued warnings in 2006 and again in 2014 advising against use of these products in children under the age of 2.