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Teething Care & Anticipatory Guidance
Teething and symptoms attributed to teething are a common concern of parents. A number of studies have looked at teething and associated symptoms, with the largest study observing that the symptoms of "increased biting, drooling, gum rubbing, sucking, irritability, wakefulness, ear rubbing, facial rash, decreased appetite for solid foods, and mild temperature elevation were all statistically associated with teething.” Symptoms not associated with teething included congestion, cough, sleep disturbance, decreased appetite for liquids, vomiting, and loose or increased stools. Furthermore, no single symptom occurred in more than 35% of infants.

Given these findings, it is important for clinicians to remember and inform parents that, although some symptoms do seem to be associated with teething, none of these symptoms consistently and accurately predict when teething is about to occur. It is also important to know that more serious symptoms such as fever (temperature >100.4º F) and diarrhea should not be attributed to teething and may require further evaluation to rule out a bacterial source of infection.

The safest recommended intervention for teething is the use of cold items because the cold acts as an anesthetic for the gums. Refrigerated teething rings, pacifiers, spoons, clean wet washcloths, and frozen bagels or bananas are all good choices. However, teething rings should be placed in the refrigerator only (not the freezer) to prevent infants from developing fat necrosis.

Topical teething gels sold over-the-counter (OTC) are often used for teething; however, these gels can carry serious risks, including local reactions, seizures (with overdose), and
Methemoglobinemia: The presence of methemoglobin in the blood due to conversion of part of the hemoglobin to this inactive form .
methemoglobinemia (in published case reports). If necessary, parents should be instructed on proper dosing of OTC analgesic medications, such as acetaminophen or ibuprofen.
There are no symptoms that consistently and accurately predict teething.
Fever, vomiting, diarrhea, and cough or congestion should not be attributed to teething and may require evaluation.
Teething rings should be refrigerated only to prevent infants from developing fat necrosis.
Parents should be made aware of the potential dangers of over-the-counter topical teething gels.
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