A teething baby is part of a new parent's first 'trial by fire'. There's the hours of crankiness, low-level fevers, constant drooling and the urge to gnaw on everything — even the family dog.
And parents beware: Starting around 6 months old, babies get one new tooth every month for a total of 20 teeth. Teething typically last until 3 years of age.
To make matters worse, teething coincides with constant change in a baby's life that can add to the angst.
Teething is often wrongly blamed for sleep disturbances, decreased appetite, congestion, coughing, vomiting and diarrhea. But these symptoms may signal other potentially grave health conditions, according to the American Academy of Pediatrics.
In an attempt to soothe teething pain, well-meaning parents, grandparents and caregivers too often want to rub prescription or over-the-counter (OTC) numbing medications on the tot's gums. But health experts agree that some of these medications are potentially harmful to the baby.
The U.S. Food and Drug Administration is warning parents not to use a prescription local anesthetic called viscous lidocaine, or any teething products sold OTC containing benzocaine.
“These products are not safe for treating teething in infants or young children, and they have hurt some children who used the products,” the federal health agency said in a statement.
Teething is a normal part of childhood that can be treated without medications, says Ethan Hausman, M.D., a pediatrician and pathologist at FDA. "FDA does not recommend any sort of drug, herbal or homeopathic medication or therapy for teething in children."
In 2014, FDA reviewed 22 cases of serious adverse reactions. These included deaths in infants and young children ranging from 5 months to 3.5 years of age who were given oral viscous lidocaine 2 percent solution for the treatment of mouth pain, including teething and stomatitis, or who had accidental ingestions.
Parents or grandparents may have viscous lidocaine on hand if it has been prescribed to treat another family member for pain relief.
Doctors prescribe viscous lidocaine for cancer patients (children and adults) who are unable to eat because of mouth ulcers that can occur with chemotherapy, and dentists sometimes use it to reduce the gag reflex in children during dental X-rays and impressions.
Viscous lidocaine is a local anesthetic in gel-like syrup. It should never be used to comfort a teething baby.
The Institute for Safe Medication Practices (ISMP ), a nonprofit organization dedicated to preventing medication errors, has received reports of teething babies suffering overdoses of viscous lidocaine. Symptoms include jitteriness, confusion, vision problems, vomiting, falling asleep too easily, shaking and seizures.
The drug also "can make swallowing difficult and can increase the risk of choking or breathing in food. It can lead to drug toxicity and affect the heart and nervous system," said Michael R. Cohen, a pharmacist and ISMP president, in a statement.
Some parents have repeatedly applied viscous lidocaine to calm a fussing baby, said Cohen. Some have put liquid gel forms of a topical anesthetic into a baby's formula or even soaked a pacifier or a cloth in it, then put that in their baby's mouth. How much the baby gets is not measured, so it may be too much, he said.
Benzocaine is a localized anesthetic found in OTC products such as Anbesol, Hurricaine, Orajel, Baby Orajel, and Orabase.
Using benzocaine gels and liquids for mouth and gum pain can lead to a rare but serious — and sometimes fatal — condition called methemoglobinemia. This is a disorder in which the amount of oxygen carried through the bloodstream is greatly reduced. Children under 2 years old appear to be at particular risk.
So what are some safe, non-toxic ways to take soothe baby’s swollen, tender gums?
- Gently rub or massage the gums with your finger
- Give your child a cool teething ring or a clean, wet, cool washcloth to chew on. The coolness soothes the gums by dulling the nerves which transmitted pain.
"A cool object acts like a very mild local anesthetic," says Hari Cheryl Sachs, M.D., a pediatrician at FDA. "This is a great relief for children for a short time."
Simply chill the teething ring or washcloth in the refrigerator for a short time, making sure it's cool — not cold like an ice cube. If the teething ring is too cold, it can also be harmful to baby.
The FDA recommends parents should always supervise babies and toddlers so they don't accidentally choke.
Lynette Summerill is an award-winning writer and watersports junkie living in San Diego. In addition to writing about cancer for EmpowHER, her work has been seen in publications internationally.
Teething. U.S. National Institute of Health.
Do teething babies need medicine on their gums? No. FDA. 26 June 26, 2014.
Over-the-counter benzocaine sprays and gels used to relieve mouth pain can cause a fatal blood disorder. ISMP Safe Medicine, May/June 2011, Volume 9, Number 3. Accessed 26 June 26, 2014.
Teething. American Academy of Pediatrics. 2012.
Reviewed June 30, 2014
by Michele Blacksberg RN
Edited by Jody Smith