On Saturday, the FDA released a recall of Hyland’s teething tablets. The recall stems from concerns for increased and varying amounts of belladonna, a toxic substance that could cause serious systemic effects to babies. It’s unclear how much belladonna is found in these tablets normally although it is well known it’s in them. Recently, infants have developed symptoms consistent with belladonna toxicity after using the tablets (change in consciousness, constipation, skin flushing, dry mouth). Homeopathic supplements and medications are unregulated and therefore it’s hard to know what is in them, how consistent one bottle is from the next, and how different brands of the same products compare. Local and national poison control previously deemed teething tablets safe even though it is known that they have trace amounts of belladonna (and possible caffeine). The FDA states it is “unaware of any proven clinical benefit from the product.” Because of safety concerns and no known benefit, I’ve always recommended against using teething tablets. If it were my child, I didn’t, and would not use teething tablets. If you have these at home, throw them out. Here’s some FDA tips of safe disposal of unwanted medications. If your child has had these tablets in the past, there is no reason to worry. Ill effects would have been seen soon after using them.

Some Teething Truths:

  • Teething commences around 4-12 months of age and continues until around 24 months, although variability is the norm. Late teethers are very common (first tooth after 9 months) and not worrisome. I recommend you see a dentist after 12 mo of age for routine preventative screening. If there are no teeth by 14-15 months, that’s when a work-up (like getting x-rays) would begin.
  • Drooling does not necessarily mean your child is teething. Don’t let the grandparents, neighbors and friends fool you. Drooling picks up readily after 3-4 months of age as a result of your baby’s increased exploration by mouth (gnawing and pulling hands in mouth) and to facilitate digestion. Prior to a big burst of drool, babies explore through their sense of sight and hearing; as 4 months hits, they start to explore through taste. Although there can be an up-spike in the volume of drool if a tooth is on its way, it’s not a perfect flag for the event.
  • Teething discomfort is uncommon. Most babies are utterly unphased by teeth popping through, others may show discomfort. In my office, parents often report the experience of discomfort when their child is teething. This may be true for some babies, but don’t expect to see pain with teething. All babies are different but research does not associate teething with pain, runny nose, fever, or diarrhea. If your baby has a fever while teething, it’s likely from another source (i.e. viral infections, ear infections). If your baby has a fever over 100 and you are concerned about pain, don’t assume it’s teething; call or visit your doctor for help.
  • When teething, most babies love to chew on things. I often say to parents, it looks like they have itchy teeth! I learned this while watching my boys pop teeth; it really appeared like they wanted to scratch them. But don’t misinterpret chewing behavior for pain and reach for medications. You don’t have to medicate the urge to gnaw….
  • Nearly all babies pop their lower central incisors (two middle teeth) first and then the rest of the mouth fills up. Babies get about 1 tooth/month after their first incisors come in. Order and timing are extremely variable–some babies get one tooth every month while some infants pop 4-6 teeth all at once!

Medications Marketed for Teething:

  1. Tablets (homeopathic teething tabs like those recalled). I never recommend these. There’s no good evidence that they work. Why give your baby something that potentially can have negative effects with no proven benefit? Regarding homeopathic supplements The Medicine Guy explains today, “The terms dietary, natural, and homeopathic convey a sense of safety. Cultural beliefs, positive reviews from friends, effective selling techniques, and wishful thinking contribute to the impression that a product will be effective for its intended use. Unfortunately, it is not often that we have the clinical evidence to support the effectiveness of most of these products.” Furthermore, never rub aspirin or any other medication on your baby’s gums.
  2. Gels (a local anesthetic–usually benzocaine– to numb the gums) like Oragel/Baby Oragel. I don’t like these. First of all, if any of you have tried using these, they numb up your mouth leaving you with a fuzzy, funny feeling inside. They only work on superficial skin, not necessarily targeting the area of possible discomfort below the gums where teeth are moving. Lastly,  I don’t like the idea that these gels can potentially numb the back of the throat as they are swallowed by infants, setting a baby up for difficulty swallowing or choking-like behavior.
  3. Liquid Pain Relievers.  These are the safest and most effective medication for teething. The only medication I ever recommend is Tylenol (acetaminophen). I don’t recommend ibuprofen or motrin for teething (risks outweigh the benefit).

If a baby is teething, reach first for symptom relief with teething toys. Then try Tylenol if you believe your child is in pain.

How To Help Teething Symptoms (Without Medications):

  1. Teething Toys: find someone for your little gnawer that’s cool to touch but tough to chew on: wet washcloth chilled in the freezer for 15-30 minutes, a frozen banana or berries if you’ve introduced solids, solid (not liquid filled) teething rings chilled in the fridge or freezer (take them out before they are rock hard), a frozen bagel, your finger, or a lovie type toy. If your baby is over 6-9 months, offer a slow flow sippy cup of cool water to suck on and drink for comfort. Of note, plastic teething rings with liquids have been given a bad name in the past few years due to recalls–potential bacteria growing in liquid and the possibility of a baby cutting through the ring and into the liquid. As many parents try to avoid plastics (phalates/BPA), I suggest using the washcloth method or a cotton sock rolled up tightly to gnaw on. Silicone and latex chewy toys may be a safer bet. One of our of our boys loved loved loved the Girafe (spelling intentional) teether that is popular right now. And some babies who seem irritated by teething may enjoy having a pacifier to suck on.
  2. Fingers: Let your baby gnaw on your fingers (if the teeth haven’t come through) or rub their gums with your clean fingers for comfort.
  3. Massage: If you’re breastfeeding and your baby isn’t interested in a teething toy or more interested in chewing on your nipples (eeeeeek) or your arms, especially around the time of feeding, massage their gums with your fingers dipped in cool water prior to starting a feeding.

Clean the teething toys, washcloths, or socks after each use. And know, it’s absolutely fine to let your baby chew all day if they enjoy it. Still, nothing about gnawing means pain.

What other interventions worked for you & your baby?