The Kids

Parents Can’t Handle the Tooth

Moms and dads blame teething for their infants’ sleeplessness, crying, fevers, and diarrhea. They’re missing the real cause.

Teething is just one of the many, many things that make babies cry.

Photo courtesy of Shutterstock

When my daughter was 7 months old, she abruptly stopped sleeping through the night. She was up every couple of hours, crying and demanding comfort. Teething, I thought. It was around the right time for her first teeth to emerge. But weeks went by, and I saw no teeth, and the middle-of-the-night disruptions continued. I morphed into a mom-zombie, surviving on caffeine and chocolate.

When it came time for me to bring her to the pediatrician for a routine visit, I described our ongoing nocturnal woes. The doctor looked at her gums. “She’s not teething,” he said, and she was perfectly healthy. I didn’t believe him and made him check again. I mean, she had to be teething—there had to be a real, physiological explanation for my forced descent into the ninth circle of hell. Right? “Nope,” he said. “So what’s going on, then?” I demanded. He smiled and replied, “It looks like she’s been sleep training you.” He was lucky to escape without a mom-zombie bite.

I’ve been trying to think of a more eloquent way to say this, but I can’t, so: Teething sucks. We as parents know that teeth are going to appear, but we never know exactly when or what symptoms will precede them. Plus, babies are a roller coaster of evolving behaviors anyway, so when little Anna suddenly becomes a train wreck, we have no idea whether it’s because a tooth is coming or because she’s sick or because, well, she’s 10 months old. As confused, sleep-deprived parents, we desperately need explanations for our infants’ strange developments, and teething is a convenient crutch—but it’s one that we may rely on too often. The fact is that no symptom reliably predicts the eruption of a tooth because babies react differently. The one fact experts seem to agree on—but that many parents, including myself, are reluctant to accept—is that true teething symptoms are generally pretty mild.

Let’s start with the oft-cited claim that teething causes excruciating pain because a tooth is “stabbing” through the gum. “That’s one of those myths,” explains Clay Jones, a pediatric and newborn hospitalist at Newton-Wellesley Hospital in Newton, Massachusetts, who wrote about teething for the popular blog Science-Based Medicine. “What happens is that the gums remodel—they move out of the way as the tooth emerges.” After all, Jones says, gums don’t bleed when kids teethe. A 2003 study documented a statistically significant increase in one inflammatory marker during infant teething, but the rest of the markers the study tested, called cytokines, didn’t change much. “A baby might be in pain or having some degree of discomfort, but I think that a significant amount of pain is not likely or plausible,” Jones says.

Indeed, if teething caused tremendous pain, one would expect kids to have consistent symptoms—but they don’t. In one of the most carefully conducted studies on teething that’s ever been done, researchers in Brazil sent dentists into the homes of 47 babies every day for eight months. They took the babies’ temperatures, checked their gums, and interviewed the parents about their infants’ behaviors. The study found that teething was associated with sleep disturbances, drooling, rashes, runny noses, diarrhea, appetite loss, irritability, and slight rises in temperature (not clinical fevers). But the interesting thing is that these symptoms consistently occurred only on the day that a child’s tooth erupted and one day after. No symptoms regularly occurred in the days before the tooth appeared.

Another study relied on parents who were employees of the Cleveland Clinic to report the timing of their babies’ tooth eruptions, their temperatures, and other symptoms. It found that biting, drooling, gum-rubbing, irritability, and sucking tended to be more common up to four days before a tooth appeared and for as long as three days afterward. More serious symptoms, such as sleep awakenings, decreased appetite for solid foods, facial rashes, and slightly elevated temperatures (but not above 102 degrees), were more likely to occur one or two days before or on the same days a tooth came through. But this study found no really serious symptoms associated with teething—no diarrhea, vomiting, high fevers, or reductions in the overall duration of sleep.

Importantly, the researchers found that so-called teething symptoms frequently occurred in nonteething infants, too—it’s just that they were more likely to happen when the infants were teething. They also found that no specific symptom occurred in more than 35 percent of teething infants. In other words, nonteething kids often seem like they’re teething, and teething kids don’t all have the same symptoms. What a nightmare for parents. “Despite hundreds of thousands of data points,” explains study co-author Michael Macknin, a Cleveland Clinic pediatrician, “we could not determine when a child was teething before a tooth appeared.” The one thing Macknin could say for sure based on his data was that “a baby who drools or is fussy for weeks before a tooth eruption is not having symptoms due to teething.” My doctor was right, then. Those several sleepless weeks did not have anything to do with teething because the emergence of a tooth simply does not take that long.

So why, then, does teething seem like the worst thing ever? In part, it’s an artifact of the difficult psychology of parenting. Babies rapidly change; they go through difficult periods; they get sick a lot. Yet they can never tell us what’s wrong, so we have to guess at the causes. And what’s something that happens a lot in infancy that we can blame everything on? Oh! Teething. “It’s the nature of being a human—when we’re faced with nonspecific symptoms like fussiness and drooling and changes in sleep, we want to peg it on something,” Jones says. This is not a new thing. Centuries ago, teething was thought to be associated with worm infestations. In 1839, more than 5,000 deaths were attributed to teething. And sadly, some traditional African healers still pull out tooth buds in teething babies—without anesthesia—in an effort to cure them of what they think are “tooth worms.”

There’s another factor that contributes to the widespread belief that teething causes nasty symptoms, and that’s confirmation bias. Let’s say your baby gets diarrhea for a few days. You think, “He’s teething!” But days go by, and he gets better, and no tooth emerges. You conveniently forget the fact that you were wrong. A few months later, he gets diarrhea again, you think he’s teething again, and a tooth does appear. This time you conclude you were right—and you’re much more likely to remember your success and conclude that diarrhea has something to do with teething. In other words, when it comes to the accuracy of our parental diagnoses, “we forget the misses and remember the hits,” Jones explains. Chances are, though, that even the second bout of diarrhea was caused by something other than teething—but because teething happens so frequently, symptoms of other conditions often coincide with the appearance of new teeth, and the two seem related.

Remember that Brazilian study I mentioned—the one in which they got dentists to record things about babies for eight months straight? Well, one week after they finished the study, the researchers went back to the mothers and interviewed them about their babies’ teething symptoms. They found that the moms were likely to report fevers as a symptom of their babies’ teething even when their babies never had fevers during teething. The moms were also likely to have forgotten about milder teething symptoms, such as drooling. The researchers speculate that these mistakes are probably due to memory bias—new parents can’t remember everything!—and because of “the widespread belief that teething can cause fever.” In other words, because we have come to believe and expect that teething causes serious symptoms, we may be more likely to think our own kids had such symptoms even when they didn’t. “There’s so much force behind the concepts of teething passed down from grandmothers to moms and society in general to moms,” Jones explains. “It’s reinforced over and over again, so much so that it’s kind of a self-fulfilling prophecy. You’re going to look for these symptoms and then blame them on teething.”

This brings us to an important point: If your kid is having serious symptoms, don’t shrug them off as being related to teething. I made this mistake last week: My now-9-month-old daughter was extremely fussy, and I assumed she was teething. (When will I learn?) The next day, she awoke with a fever of 103 degrees, and I realized she was actually sick. One study found that out of 50 kids who had been experiencing symptoms that their parents or doctors had initially attributed to teething, 48 of them actually had other conditions—one, in fact, had meningitis. So if your baby has diarrhea, is vomiting, has a high fever, or is inconsolable, you should contact your doctor instead of giving her a teething ring.

Speaking of treatments: Since teething is so hard to predict, parents should be careful about administering teething remedies—especially ones that aren’t risk-free. Parents tend to think of Tylenol (acetaminophen) and Advil (ibuprofen) as completely safe, but overdoses occur and can be very dangerous. The American Academy of Pediatrics also warns against the use of topical teething gels containing lidocaine or benzocaine because they can cause local reactions and rare but serious side effects including seizures and brain injuries. Amber teething necklaces can cause choking and strangulation, and there’s little reason to think they work. And homeopathic teething tablets, such as those made by Hyland’s, are also likely to be a waste of money. If you think your baby is teething, experts agree that the safest remedy is a refrigerated—not frozen—teething ring for her to gnaw on. (Even frozen bagels, my sources said, are a bad idea because they can be choking hazards. Argh!)

I know, I know—as a parent, you don’t want to hear this. You want answers and solutions. But one of the reasons we want so terribly to understand and label what happens with our kids is because, on some level, we believe that with understanding comes control. If I know what it is, I can do something about it. But trying too hard to understand can backfire, too. Had I not decided that my daughter was teething a few months back, I wouldn’t have coddled her every time she woke up at night, and she might not have continued the habit. I know this because the night after I saw my pediatrician, I backed off—and after waking up at 2 a.m. and crying for a few minutes, my sweet little angel went back to sleep and slept the rest of the night. If only I’d resisted the temptation to find a scapegoat, there would have been one fewer mom-zombie shuffling around the neighborhood.