Typical infants have 20 primary (baby) teeth which have started to develop in the womb. The teeth start to erupt through the gums around 6 months of age. The baby teeth are then shed at various times throughout childhood. At the end of this post, you will find a chart with the typical range of ages when most teeth start to come and go.
Over the years, I have seen kids that didn’t care about the rules, ignored the charts and did things their own way. I know of one baby who was born with teeth! Another started out with the upper canines and looked like a little vampire. As you can imagine, those parents were so happy when the rest of the teeth popped through. There is some heredity involved. If one of the parents was very early or late it is possible for the baby to follow suit. If you are lucky enough to have the option, check with grandma to see if she remembers anything special about your teething pattern!
It is rare for teeth to actually make an appearance before 4 months. Once in a while parents will notice a smooth round white bud on a baby’s gum. This is a little benign cyst called an Epstein Pearl. It is not a tooth and it usually goes away without causing any bother.
Many parents think of teething as something they are only dealing with for their young infants. Think again. If your 6 year old is going through an extremely grumpy phase, or has a mysterious bout of mild, clear congestion that has been hanging on for a few weeks, take a feel in the back of the mouth and see if those first permanent molars are starting to pop through. Once your child reached the age of 21, all 32 of the permanent teeth have usually erupted and they can no longer blame their grumpiness on teething.
Just like the timing varies, the symptoms may also vary greatly from child to child and even from tooth to tooth. By far, the most common first teeth are the ones in the bottom middle (and they are so cute once they come through).
 |
Take your clean finger and run it along your baby’s gum. If the tooth is imminent you may feel that the area of the affected gum feels soft and boggy.
Let's talk about the symptoms.
Many healthcare providers and dentists dispute that there is any real relationship between teething and any of the symptoms below, but I have been an advice nurse for a long, long (long) time. I used to speak to parents of teething babies all of the time, and I maintain that there is a connection.
Fussiness: Teething is uncomfortable. Most parents report that the babies seem fussier than usual right before a tooth pops through. Do what you can to relieve symptoms (see below), but if your baby is inconsolable (screaming with NO break) for more than 30 minutes and there is nothing you can do to calm them down, please call your pediatrician to have them checked. That would be an extreme reaction to blame on teething and it would be good to see if there is something else going on.
Drooling: Drooling starts weeks and sometimes months before you actually see a tooth pop through. Many kids will get a drool rash on their chins and cheeks. There are several products that I find quite useful for this. Clean off the area with a gentle cleanser (Cetaphil is a good brand where there is no water needed, apply with a cotton ball and wipe off). Follow it up with aquaphor, cerave ointment or simple petroleum jelly. You can use any of these multiple times throughout the day. A mild drool rash (flat redness without cracked or broken skin) does not necessarily require treatment. No judgment if you chose not to fuss with it.
Gnawing/biting: Biting on things will feel great to the baby; not so good to your nipples if you are nursing. There are quite a few differing opinions about this, by all means follow your own instincts!
The most gentle parenting approaches will suggest that if your baby starts biting you during feedings, try to stick your finger in their mouth to break the connection, say their name, pat them on the back and then calmly take a break from the feeding. Most babies can be trained to stop this.
However, if the issue persists, I actually recommend a loud “ouch!!” and immediately remove them from the breast. Sometimes you may need to make the association mildly unpleasant to break the habit. Biting = the potentially loud, well deserved yelp and loss of breast! If you are too gentle some babies will think it is quite amusing and will continue to bite at will.
It’s not just your breast that they are chomping on. You might notice that even more than usual, kids will try to put absolutely everything in their mouths. Even the screen door isn’t safe
 |
Poor Sleeping: If your little one is miserable, in my opinion, this is not the time for sleep training. I would go in quietly and try one of the teething remedies listed below. If you are going through a rough patch remember that parents should take shifts (if you are a single parent I send you a hug). Give yourselves each a few hours when you are off duty. There is no reason for both of you to be up all night. If you have the option, it is often best for the NON-breastfeeding parent to go in, unless it is time for a feeding. This is a slippery slope; I would try not to feed for comfort throughout the night.
Bleeding/bruised gums: It is not unusual to have a little bit of bleeding on the gums. Once in a while you may also see a purple/bluish bruise on the gums right before a tooth breaks through (official term for this is an “eruption cyst”). This will usually resolve without any intervention although something cold will feel soothing.
Mildly elevated body temperature: Many dentists are of the opinion that teething does not cause an actual fever, but I commonly see it associated with an elevated temperature. Six months is often when babies are losing some maternal antibodies, so the timing might indeed be coincidental. In any event, if a fever goes higher than 100.5 then I am not likely to blame it on teething. Any fever that is lasting more than three days is worth a call to the doctor's office to check in.
Loose stools: just like with fevers, you will likely get differing opinions on whether or not teething can be the culprit and again; I will state here that it is common enough that I think there is a connection. Some folks speculate that swallowing all that saliva and drool might be the reason. If you have a baby with loose stools, you may want to go with the bland, starchy diet and consider trying probiotics. Breast milk is safe, but other milk-based products may aggravate the situation.
Rashes: If your child has sensitive skin and/or eczema sometimes, you might notice that the general rashiness flares up during active teething. This includes the diaper area.
Congestion: Many young teething kids seem to have a clear runny nose and congestion. This can last for weeks and weeks. Sometimes it causes a post nasal drip that in turn causes a little hacking cough.
Ear tugging: When kids are working on some of the upper teeth they tend to poke and play with their ears.
Uh oh, many of these symptoms are the same thing we look out for if we suspect an ear infection. Even though teething may well be the cause, if you are dealing with a child who is very fussy, feverish, and is having trouble sleeping, I suggest you have someone take a peek in those ears.
It is worth having an arsenal of tools at the ready for dealing with the months of teething that you have ahead of you.
Gum massage: Not every infant will let you stick your finger in their mouth to rub their gums. And if they already have some teeth, you might earn some extra hazard pay. But if they’re struggling on cutting their first set, a simple massage with your fingers is the easiest and most cost efficient intervention available.
Frozen washcloth: Wet half of a washcloth and put it in the fridge or freezer. The baby will be able to hold the dry half and chomp happily on the frozen side. For an interesting twist, consider soaking the washcloth in chamomile tea before chilling it.
Distraction: There is nothing as nice as a body massage and a warm bath by a calm singing parent.
Feeding bags (baby safe feeder, or sassy teething feeder): If your baby has had some solid foods introduced, these feeding bags are great for teething relief. Add a cold hunk of fruit or veggie (pick a food that they have been introduced to already so that you don’t need to worry about any odd reactions) and let them gnaw away happily. With the mesh bag you don’t need to worry about them breaking off a piece that could be a choking hazard. You can find these bags online pretty easily.
You can also fill one of the bags with a frozen ‘Milksicle'. Take 3 or 4 ounces of breastmilk, or formula, and combine it with some fruit, like banana, pear or mango. Puree until very smooth and stick it into an ice cube container. Pop out a frozen cube and add to the mesh feeding bag. You could also just use plain frozen breastmilk.
Cool cucumbers: Cool cucumbers can feel like a spa in your mouth! This is for kids who have proven themselves to be able to handle actual pieces of food, but for your toddlers who are cutting teeth, these might be a hit. Peel the cucumber, slice into circles, get rid of the seeds. Put the cucumber circles in a bowl in the fridge to keep cool.
Chewing options:
Cool teething rings: make sure they are made out of a safe material. Do not tie any teething rings around your baby's neck.
Chew beads: I have had multiple parents tell me that these beads seemed to help but make certain that they are not a potential choking hazard. Check carefully that nothing that can get loose. Your little one needs to be supervised when using them. These should never be in a crib. I worry about strangulation with any necklace.
Chinese herbs: There are very safe pediatric herbal tinctures. One, called Tender Teeth, can be obtained at The Acupuncture Den, a family practice located in San Francisco. Please contact Dr. Den to arrange a pick-up or mail delivery if you’re not in the city. Beyond just the herbs, an acupuncturist can offer relief with acupuncture and/or non-needle techniques. Many parents report babies taking a long and deep nap after a treatment!
Homeopathic drops: The ones I am most familiar with are Camilia by the Boiron company. Click the Boiron link for a coupon.
Orajel: Orajel’s new formula is safe. The older formula which actually numbed the gums was recalled years ago due to safety issues. Make sure you read the labels carefully to make sure that it is Benzocaine free.
Brandy/alcohol: Ask great grandma what she used to do for teething and she may tell you that she used to put whiskey or brandy on the baby’s gums. Obviously giving our babies alcohol is not something that most doctors would suggest today: I cannot officially endorse doing this on your own as medical advice. But I actually wouldn’t worry if you caught grandma rubbing a drop or two directly on the gums, it probably does help. Some folks also say that rubbing pure vanilla extract on the gums is an effective home remedy. That may be from the alcohol content (I am referring to a tiny amount applied topically, no swigging booze!)
Acetaminophen (Tylenol) and Advil (Ibuprofen) are useful but I prefer not to overuse them. Make sure you are using the proper dose.
Start with the other approaches first. If possible, I would prefer to keep these as remedies for night time use only. Tylenol and Advil are quite safe but if they are used for a long period of time they can be stressful to the liver and kidneys. If you find that you have gone more than 5 nights where you are depending on these meds to keep your child comfortable, give your doctor's office a call to see if you need to make sure that nothing else is going on.
DO NOT USE
Any product that contains Benzocaine or Belladonna!!
Once your child has teeth, it is especially important to keep bottles out of the crib. Milk has sugar and can cause tooth decay if a baby sleeps with a bottle in their mouth. It is never too early to start brushing the teeth. Let's get your baby in good dental habits. It is important to use a soft toothbrush and non abrasive toothpaste. The current recommendation is to use fluoride toothpaste; just a teeny bit the size of a grain of rice.
 |
Once they have a mouthful of teeth it makes sense to start shopping for a pediatric dentist that you can establish a relationship with. This will come in handy if you have any tooth questions or mouth injuries.
Your next task is to figure out what the going rate for the tooth fairy is! I can’t help you there.
Wishing you easy teething!
 |
 |
Updating this post was inspired by Coby, who has all of the teething to get through
Thanks to my models EJ and Sawyer who have beautiful smiles
And as always enormous thanks to Dr. Ted who helps me achieve the the balance of data and collective wisdom.
No comments:
Post a Comment