I have lost count of the number of times over the past couple of months that I’ve attributed the Troll’s grumpiness or fussiness when being put to bed down to teething, waiting patiently for these teeth finally to come through, with no avail. Two months since everything started being a sign for this teeth coming through, he still only has the two,
Like many, many parents (and a surprising number of doctors and nurses, too), I had completely the wrong idea about how teething works and the symptoms associated with it.
There are a whole bunch of symptoms people think are caused by teething, but there’s very little solid evidence that the onset of one or a collection of any systemic symptoms is predictive of teeth coming through.
The scientific consensus is that systemic symptoms like decreased appetite for liquids, blocked noses, sleep disturbances, diarrhea, vomiting, coughing, rashes, or fever higher than 38.9°C are not caused by teething and should not be attributed to teething – they are usually sign that something else is wrong and may be an indication of something more serious.
Prospective studies, where parents write down all the signs and symptoms they notice in their child, whilst a dentist regularly checks the child’s teeth development, have produced mixed results when it comes to determining which symptoms are actually caused by teething, but they have led to the the identification of an 8-day teething window, which includes the 4 days before tooth eruption and the 3 days following.
The symptoms seen most consistently in this period are biting/ mouthing, drooling, gum rubbing, and irritability. Decreased appetite for solid foods and mild, low-grade fever (38.9°C) have also been reported. However, it’s important to bear in mind that the presence and severity of any symptoms and signs of teething varies considerably between individuals, and that the symptomatology cannot predict the emergence of a tooth/teeth. Many of these symptoms occur on the actual day of the tooth eruption or the day after, not necessarily before.
The tricky thing with teething, which in most children happens between 6 and 12 months of age, is that it happens at exactly the same time that (1) the child is developing their own immune system instead of relying on the immune system passed on to them through the placenta and then supplemented via breastfeeding (if they are breastfed), and (2) the child is more mobile and also exposed to a greater number and variety of new environments, and therefore more likely to be exposed to more germs. These two things leave children at this age much more susceptible to a myriad of relatively minor infections that lead to symptoms like fever and diarrhoea. At the same time, kids are also undergoing huge psychological and physical changes, which can lead to irritable behaviour and disrupted sleep.
Because these things happen so closely together, it’s not surprising that many parents, including myself, make a correlation-causation error and think that symptoms like blocked noses, irritability, loose poops, and for us, especially, sleeplessness, are linked with teeth coming through.
I hadn’t really thought about it before I started looking into it, but misattributing symptoms to general teething pains can be a serious problem. In one study, of the 50 kids taken to hospital because their parents thought they were having teething trouble, 48 were diagnosed with a genuine medical condition, including a case of bacterial meningitis. Something else, which definitely applied to us before I did some reading up, is that restlessness and sleeplessness attributed to teething can prevent parents from implementing appropriate behavioural and sleep management strategies.
The relationship between the parent and child plays a huge role in how the teething issue plays out. Because children cannot articulate the type or extent of the pain they might be in, it’s up to the parent(s) to interpret what’s going on. Here, all kinds of subjectivity creeps in: two people observing the same child’s symptoms might interpret them very differently – one might just see it as the child ‘being a bit grumpy’, whilst someone else, who is perhaps more sensitive to or on the lookout for ‘signs’, is more likely to notice and misattribute symptoms, and be more likely to fall foul of a self-fulling prophecy. This ‘reporter bias’ makes it difficult to interpret the findings of prospective studies of this kind, which often rely on caregiver questionnaires, with any real confidence.
The teething problem also isn’t helped by the fact that a lot of information on parenting websites incorrectly reinforce the idea that there is a connection between teething and non-specific systemic symptoms, and they do not do a good job of communicating the potential adverse side effects of common teething treatments.
It is further compounded by the fact that a considerable proportion of physicians and nurses (who are also parents!) also hold mistaken beliefs about the relationship between many systemic symptoms and teething. It’s unlikely that a parent will change their mistaken beliefs about teething until healthcare professionals change theirs (or, like me, they spend a few hours digging around PubMed, which isn’t everyone’s cup of tea). I’m seeing the Troll’s healthcare worker on later this week for his 10-month check-up and now I’m really interested to find out just how evidence-based her answers to my questions about teething will be.
I think the take-away here is that it is important that teething is not used as a blanket diagnosis, either to explain the symptoms of a potentially serious illness (which could have really bad consequences), or explain away normal childhood behavior (which makes parents more anxious or leads to them misplacing their anxiety, which is also (but comparatively less) bad).
I had in mind to write about treatments for teething too, but this post is already a little too long, so I’ll save that for another day.
- Kozuch, M. and Auria, J.P.D. (2014). Infant Teething Information on the World Wide Web: Taking a Byte Out of the Search. Journal of Pediatric Health Care. 29, 1.
- Macknin, M., Piedmonte, M., Jacobs, J., Skibinski, C. (2000). Symptoms associated with infant teething: a prospective study. Pediatrics. 105, 747–752.
- Markman, L. (2009). Teething: Facts. Pediatric. Review. 30, e59–e64.
- Owais, A.I., Zawaideh, F., Bataineh, O. (2010). Challenging parents' myths regarding their children's teething. International Journal of Dental Hygiene. 8, 1, 28—34.
- Sarrell, E. M., Zeev Horev, Z. Zeev Cohen, Z. (2005). Parents’ and medical personnel's beliefs about infant teething. Patient education and Counseling. 57, 1, 122–125.
- Sood, S., Sood, M. (2010) Teething: myths and facts. Journal of Clinical Pediatric Dentistry. 35, 1, 9—13.
- Wake, M., Hesketh, K., Lucas, S. (2000). Teething and tooth eruption in infants: a cohort study. Pediatrics. 106, 1374 –1378.