Tag Archives: teething

“It must be his teeth”: teething symptom myths

I wrote some time ago about how our little one was teething and the measures we’d taken to alleviate his discomfort. Well, this little chapter is still in full swing, with a mere two teeth erupted so far. But this isn’t a place to write long diary entries detailing my child’s progress; instead, I want to bring some science to light.

I’ve heard a number of physical signs regularly attributed to teething, such as rosy cheeks, diarrhoea, green faeces, fever, gnawing, irritability and drooling to name a few. It seems these beliefs are fairly common, as surveys of parents and health professionals have shown.

It gets interesting, however, when you look at some of the research done in this area. There seems to be some disagreement over which symptoms are actually caused by teeth eruption, and whilst it’s clear that individual babies will display different teething signs, it’s also apparent that some beliefs are not borne out by the evidence.

One of the difficulties is that the onset of teething (6-12 months) often occurs around the same time that babies become particularly susceptible to a variety of infections and upsets. This is mainly due to the decline in immunity imparted by maternal antibodies, as well as changes in behaviours that see infants actively interact with their environment.

There certainly seems a fair amount of evidence that many signs assumed to be caused by teething are actually caused by something else, such as meningitis, bacterial infection and herpes simplex virus infection. As the NHS Clinical Knowledge Summary bluntly puts it: “Teething does not cause children to become systemically unwell”. 

Another problem is our familiar foe: limited experimental design. Studies in this area are rather limited in number, often rely on self-reporting rather than objective measurement, deal with correlations not causations, and many look back at clinical data rather than tracking babies as they develop. These complications may be exacerbated by the fact that many health professionals hold erroneous beliefs too, which influences the data collected.

So what do we know?

Symptoms often misattributed teething:

  • Diarrhoea: This is one of the most common symptoms attributed to teething, but no solid data exist to suggest this is due to teething in the majority of cases. It has been tentatively suggested that slightly looser stools may occur during teething and this could lead to mild nappy rash.
  • Fever: Teething may cause a small rise in body temperature, but a feverish temperature above 38°C is unlikely to be due to teething.
  • Runny nose: The jury’s out on this one, but the reported associations are weak and this symptom is more likely to be a due to a wider problem.
  • Wakefulness: While teething may cause some disruption of sleep, this is probably over-exaggerated by parents, and may be partly down to changing sleep patterns and the formation of attention-seeking habits. I was also told by a midwife that teeth move more during the night, causing greater wakefulness – I initially thought not, as it seems more reasonable that the distress is apparent when there isn’t anything to distract the infant. Any data on this latter point would be gratefully received!
  • Green faeces: This is one I’ve heard a number of times, sometimes with an explanation of a change in the stomach acid balance. I can’t find anything in the literature (but please come forth and proffer!) but, on the face of it, it doesn’t seem to chime with idea that teeth eruption does not cause systemic upset.

 Symptoms more likely to be caused by teething:

  • Drooling: Excessive saliva can form and this may be seen by an infant dribbling more than usual. This isn’t conclusive, though, as salivary glands become active around 2–3 months of age and constant drooling can be expected then.
  • Gnawing: Teething infants may gnaw on cold, hard objects or on their fingers to temporarily help with teething discomfort.
  • Mild irritability: The pain associated with teething, which is mostly associated with an inflammatory response within the gums, might cause grizzliness, disturbed sleep, ear rubbing and a decreased appetite.
  • Rosy cheeks: This is some support in the literature that flushed, red cheeks are associated with teething, although this is not clear-cut.

As I said earlier, different babies will experience different symptoms and it’s worth bearing in mind that no single symptom can definitively ‘diagnose’ teething.

Many of these beliefs appear to have some root in history as far back as Hippocrates in the 4th century, when teething was thought to be a deadly disease (“dentition difficilis”, Latin for ‘difficult teeth’). Teeth eruption, it was believed, caused a disturbance in the infant’s nervous system, leading to severe systemic upset. This was, again, most probably due to coincidental timing of onset of teeth eruption and an increased likelihood of serious infection, which in those days often led to infant death. Worse still, many of the treatments used for teething right up until the 19th century were actually toxic, such as opiates, lead, mercury salts, bromide and salt.

So while some studies have suggested that teeth eruption is associated with certain physical symptoms, none has really been able to establish causal relationships, and others have found no associations at all. It may be that a diagnosis of teething can relieve parents’ anxieties about an upset infant. Understanding true causal factors, however, is important to prevent misdiagnosis – attributing symptoms to teething could miss more serious conditions that require immediate medical attention.

P.S. I was hampered in my access to a lot of the research in this area, and so if I’ve missed anything then please let me know. A good argument to support Open Access publishing!

Natural’s not in it: the problem with homeopathy for babies

I never thought I’d end up writing about homeopathy for babies, but some things just take you by surprise.

For those that are unaware, a homeopathic preparation starts by taking a substance, usually one that would cause an ailment, and dilute it down to such a degree that none of the original substance remains. The belief is that this dilution can then be used to treat the ailment and that the more diluted the preparation, the more effective the ‘remedy’ is. To give an idea of the level of dilution of most standard homeopathic preparations, the Merseyside Skeptics made ‘homeopathic vodka’ and tested it on a few willing volunteers.

The arguments against homeopathy have been made effectively elsewhere, so I won’t re-tread those well-articulated paths too heavily, but will sum it up briefly. To support homeopathy, proponents usually either ‘cherry-pick’ flimsy, uncorroborated evidence to try and prove efficacy, suggest that a placebo effect is still a positive effect (and so what’s the problem?), or simply argue that everyone has a choice to decide what treatments they use. The primary problem for me (for it’s a problem among many) is that patients replace or delay conventional treatment in favour of alternative treatment, often at a serious detriment to their health. This is exacerbated by the decision to make homeopathic treatments available on the NHS – justified by the Government with the patient choice argument – that lends validity to the practice in many people’s minds. The Science and Technology Committee, however, conclude unequivocally that it’s not valid.

So why do I bring this up here?

Well, we’re fairly sure that my little boy’s teething at the moment. This can often be a pretty painful process, as anyone who can remember those first adult teeth poking through or who have been unfortunate enough to gain some wisdom teeth. We would, of course, like to reduce Reuben’s discomfort as much as possible, and so it is with this in mind that my wife bought some teething granules, on the recommendation of some her friends who swear by this particular brand.

Now imagine my surprise when I whipped out the box, in anticipation of riding to my son’s rescue and alleviate his pain, only to discover that these were homeopathic teething granules. First, the surprise that these even exist; and second, the puzzlement that my wife, knowing my somewhat sceptical nature, had actually bought them for our son. On the second point, she assured me that she didn’t realise they were homeopathic (this fact is revealed only on the back of the packet) and was going only on the testimonials of her friends (common ‘evidence’ homeopaths produce). So I’ll give her the benefit of the doubt on that score.

But the first point, that homeopathic pain relief exists for babies, has been troubling me since. The preparation is a 6C dilution of Chamomilla (or camomile). This means that it has been diluted 10-12, or 0.000000000001 of the original substance. In the ‘homeopathic vodka’ preparation, this would have been reached by the 6th cup of water. So a pretty extreme dilution. Leaving aside the pro-homeopathic argument that camomile doesn’t cause teething (‘like with like’ theory), there’s no evidence of this substance’s pain relief qualities (as advertised) nor, as far as I could tell, of its often assumed calming properties (also this). So at a 10-12 dilution, it seems extraordinary that there would be enough active molecules to have an effect (unless one subscribes to the ‘weaker makes it stronger’ argument).

As soon I saw that this was a homeopathic treatment, I convinced my wife that we needed to buy a proper teething pain relief. We bought some teething gel, with some well-tested analgesic and antiseptic compounds in it. And this, to me, demonstrates the crux of the issue: if we’d persisted with the homeopathic treatment, then we would have delayed using the more reliable teething gel and could have caused our son a few nights of needlessly heightened pain.

I guess it may have also subsided independently of the homeopathic treatment and we would now be telling our friends about this wonderful, magical treatment for teething. And the bandwagon would roll on.