Teething: It’s Not What You’ve Been Taught

Aside from serving his own practice, Kidfixers, in Syosset, Dr. Mesibov has served as a teaching attending physician at Long Island Jewish Schneiders' Children’s Hospital for more than two decades, is an attending pediatrician at the North Shore University Hospital in Manhasset, and author of the book, "Where in the World Did You Hear That? A Pediatrician Separates Fact from Fiction." He can be reached at 516-921-2122, willmesi@prodigy.net and www.kidfixer.com.

By William Mesibov, M.D.

I can’t begin to count how many times I’ve heard intelligent parents express the conviction that teething causes fever, congestion, diarrhea, diaper rashes and pain. Although these beliefs about teething are almost universal, they’re all myths. Teething causes none of the above symptoms. The only result of teething is teeth. Where did these ideas come from? Lots of babies get their first cold, fever, or stomach virus during the second six months of life, the same period when, coincidentally, baby teeth start to erupt. Until science understood the role of antibodies and immunity, it was thought that teething somehow weakened the baby and produced illness. We now know that this is untrue.

Where in the world did you hear?

Babies usually get sick from teething.

Sound Advice

It’s not true. During the first six months, most infants simply don’t get sick. They’re protected by maternal antibodies which had come across the placenta before birth. This kind of protection is called Passive Immunity and it only lasts for a limited time. By the age of six months, most of these antibodies are gone and, coincidentally, new teeth are starting to erupt (about one or two every month.) So, here we have two unrelated events occurring at the same time: loss of immunity and the appearance of baby teeth. The baby, now low on antibodies, is suddenly more susceptible to common germs in the environment, resulting in minor illnesses, often with fever. Every episode of nasal congestion, fever, or diarrhea is due to a germ or an allergy, not to innocent erupting teeth.

The Conclusion

It’s very important to pay attention to any sign that your baby might be sick. Teething is never an answer. Always describe the symptoms to your pediatrician and let the doctor decide if any action is necessary.

Where in the world did you hear?

Drooling means the baby is teething.

Sound Advice

Drooling isn’t related to teething at all! This is another case of guilt by association:

Babies who drool are, coincidentally, often teething. The real explanation lies with the salivary glands in the baby’ s mouth. The production of saliva, present from birth, increases every month as those glands get larger. Babies swallow that saliva but they are not very good at keeping up with large volumes. Usually around four months, there is so much saliva that the baby can’t keep up by swallowing fast enough. Where does all that saliva go? It goes outside the mouth and we see it as drooling. It’s not until the baby’s swallowing capacity catches up with the saliva production, sometime after seven or eight months that excessive drooling disappears. Guess what may be happening at the time we see all that drooling? It’s the coincidental eruption of teeth. You’ll notice that, as babies get older, they still teethe but they no longer drool. So, do the teeth cause the drooling? No.

The Conclusion

Old Wives’ Tales don’t die easily. Drooling is a normal function of your developing baby, not related to teething. If the baby is out of sorts and drooling, don’t blame the teeth.

Where in the world did you hear?

Babies are cranky and don’t sleep well because their gums hurt. It helps to rub something on their gums and give them Tylenol so they (and their parents) can get some sleep.

Sound Advice

Believe it or not, there is no evidence to suggest that normal teething causes any pain. It’s true that babies do get whiney and cranky during this time. However, most pediatricians attribute this somewhat volatile behavior to increased social awareness, separation anxiety and communication frustration. It’s easy to demonstrate to parents that the gums show absolutely no evidence of irritation, inflammation or even tenderness. You can confirm this yourself by gently pressing on the gums with your finger: no pain, usually a smile. Babies usually look back at their examiner with nothing but benign contemplation when tongue blades are probing these “sensitive” areas. Can an erupting tooth ever cause a problem? Although uncommon, erupting teeth can cause slight bleeding under the gum, resulting in a tender black blister, a hematoma. Also uncommon, gingivitis, an inflammation of the surrounding gum, usually due to a virus, can create discomfort during teething. But those are rare occurrences, easily seen when inspecting the gums and should not be confused with the usual pale, slightly swollen appearance of normal, non-painful teething that the vast majority ofbabies enjoy. Further proof that teething does not hurt: ask an older child, age six or older, if it hurts when his big, adult teeth are erupting? Almost never.

The Conclusion

Most babies do not experience pain with teething and don ‘t require medicine. Don’t assume that your baby’s whining or poor sleeping is related to physical discomfort. It is a mistake to give Tylenol, Advil or any other medicine to help your baby sleep or calm down since all medicines can cause toxicity, especially if used frequently. Always consult with your doctor before dispensing any medicine to your baby.