Teething Can Gum Up the Right Diagnosis

Symptoms may signal more serious problems 

Teething in infants usually causes nothing more than a bit of discomfort and perhaps a low-grade fever or diarrhea, pediatricians say.

However, an Australian survey of physicians and nurses found that many still adhere to an outdated notion that teething can lead to a variety of ills.

As a result, health professionals could be misdiagnosing more serious problems—such as viral infections—by blaming the symptoms on teething, the survey's authors contend.

An American pediatrician says some of his colleagues in the United States could be making the same mistake.

"It's easy to pacify parents by saying, 'Oh yeah, it's teething.' But if doctors attribute [high] fever and extreme irritability to teething, they're likely to miss something important," says Dr. Joel Steinberg, a professor of pediatrics at the University of Texas Southwestern Medical Center in Dallas.

Most babies' teeth typically break through the gums when the infant is about 5 months old, Steinberg says. Teething may continue until a baby is 15 or 16 months old.

"Teething certainly causes discomfort in some children," adds Dr. Dennis A. Clements, chief of primary child care at Duke University. "Teeth erupt overnight, and some children grind their gums and teeth and cry out in pain for no apparent reason."

"Some children have a greenish stool when teething due to the stress. But there are plenty of children who get all their teeth without a whimper. It is variable," Clements says.

In the past, parents and physicians blamed a variety of symptoms on teething, from severe fevers to even death, says Steinberg, a spokesman for the American Academy of Pediatrics (AAP).

But in the last couple of decades, physicians have learned that many of the symptoms previously attributed to teething are really caused by viruses, which can strike infants as often as four to eight times in the first year of life, Steinberg says.

And those viruses can trigger health problems ranging from colds to ear infections, he says.

"I tell patients anything with a temperature above 100 is not teething," Steinberg says. "But teething can make you fussy, can make you drool a little more, and can make you sleep poorly."

The Australian researchers aimed to find out if health workers in the state of Victoria (home to Melbourne) had gotten the message about the harmlessness of teething. They surveyed 464 general practitioners, pediatricians, dentists, pharmacists, and nurses.

Their report appears in a recent issue of the British Medical Journal.

Nearly 75 percent of the nurses thought that all or most children suffered from symptoms of teething, while about 25 percent of the pediatricians did. Nurses and pharmacists were most likely to say that teething causes a variety of symptoms, and dozens of pharmacists said they had prescribed sedatives for teething infants.

Steinberg says he opposes the use of sedatives—such as Phenobarbital—by teething infants, although painkillers such as ibuprofen (Motrin or Advil) and acetaminophen (Tylenol) are appropriate. So is advising parents to give their teething babies something cool to chew on or drink.

"Topical anesthetics probably help little," adds Duke University's Clements. "They also anesthetize the tongue and throat, which may be a problem."

Always consult your child's physician for more information.

In Other Children's Health News:

Parents Surrender in Booster Seat Battle

Most parents know young children should ride in booster seats. However, many do not know at what age it is safe to graduate a child to a seat belt.

A new study finds parents are unsure about when it is safe for kids to leave behind the booster seat, a platform-type seat for older children that helps the lap and shoulder portions of their seat belt fit properly. It also finds parents who are least likely to use booster seats are those who will bargain with their kids over anything—even safety—to avoid a fuss.

According to safety experts, the time to let a child use a seat belt is when the belt fits across the shoulder and low across the hips. This occurs when the kid is about 80 pounds, 4 feet 9 inches tall, and at least 8 years old.

So, now that you know, you will insist your 7-year-old sits in a booster seat, right? After all, motor vehicle crashes are the leading cause of death among children aged 4 to 14 years old, according to the National Highway Traffic Safety Administration.

Not necessarily, say the authors of the new report, which appears in the October issue of Pediatrics, Journal of the American Academy of Pediatrics.

A major barrier to using booster seats is not just knowledge, it is parenting attitude and style. Older children can give their parents a very hard time about sitting in a booster seat, especially if their friends or siblings do not have to, or if they have already been using a seat belt, says Dr. Flaura Winston, senior study author and director of TraumaLink: The Interdisciplinary Pediatric Trauma Research Center at the Children's Hospital of Philadelphia.

Many parents, wary of the tantrums, will simply surrender.

"Parents say, 'We fight about what time he goes to bed. We fight about whether he eats his peas. I just can't bear to fight with them about something else,'" Winston says.

Researchers say this parenting attitude—that safety is negotiable—is a big hurdle in increasing usage of booster seats.

Researchers conducted focus groups and telephone interviews with 111 parents and children about their knowledge and attitudes toward booster seats.

They found parents who drew a distinction between "negotiable" rules, such as bedtime, bath time, or eating their vegetables, and "non-negotiable" rules, such as riding in a car seat, were the most likely to use booster seats.

Parents who considered all those things on the bargaining table were less likely to use booster seats.

"One key difference between parents who use booster seats and parents who use seat belts for their children is negotiability," Winston says. "Parents who used booster seats drew a distinction between safety, which was non-negotiable, and child actions like eating habits and naps… For these children, booster seats were accepted as the only option."

Winston says she tells parents to insist on only the most important issues, and safety is one of them.

"Parents are bombarded with messages about how to be a good parent," she says. "We can make it a lot easier for them. They need to pick their battles. Safety should be non-negotiable. But if a child refuses to eat their peas, well, you can give them a vitamin instead. That's not something to worry about."

Parents who did not insist on booster seats also perceived less risk of a getting into a serious car crash than parents who did use booster seats. They tended to make comments about "driving a safe car" or "being a safe driver," according to the study.

These parents also justified their use of seat belts rather than booster seats by citing state law. Most states require kids be in booster seats only until age 4, although about 13 states have since adopted more strongly worded laws.

Inconvenience and cost were other reasons cited for not using booster seats.

Stephanie Tombrello, executive director of SafetyBeltSafe U.S.A., says booster seats are available for as little as $20. Some weigh just a few pounds and can easily transported if the child is going to be in someone else's car.

Tombrello's organization has created a curriculum for kindergarten to third grade that teachers can use to introduce older kids to the idea of the booster seat. What many parents do not realize, she says, is that kids are actually more comfortable in the booster seat than when using an adult seatbelt.

The booster seat props them up so they can see out of the window. It lets them sit with good posture and with their knees bent. It helps the seat belt fit properly, rather than having the lap belt cut across their midsection and the shoulder portion in front of the face.

Many children will try to compensate for the discomfort by putting the shoulder belt under their arm or behind their back, she says. In even a low-speed crash, this puts pressure on the wrong areas of the child's body and is very dangerous.

"For children, the difference in comfort is just unbelievable when they're in a booster seat," she says.

Always consult your child's physician for more information.