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an outdated notion that teething can lead to a variety of ills.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.
|
November
2002
Teething
Symptoms May Signal More Serious Problems
What
Is Teething?
What
Are the Symptoms of Teething?
How
Can You Help Your Child With the Discomforts of Teething?
In Other Children's
Health News:
Parents
Surrender in Booster Seat Battle
Online
Resources
What
Is Teething?
A baby's first tooth usually
appears between the ages of 5 and 7 months. Some babies get their
first tooth a little earlier and others a little later. Often, the
two middle bottom teeth come through the gums first, followed by
the middle four upper teeth. By the time children are 30 months
(2 and 1/2 years) of age, all 20 baby teeth are usually present.
Teething is the process
of teeth moving and breaking through the gums. This is a normal
developmental stage for your baby.
What
Are the Symptoms of Teething?
The following are the
most common symptoms of teething. However, each baby may experience
symptoms differently. Symptoms may include:
-
drooling more than usual - drooling
may start as early as 3 or 4 months of age, but is not always
a sign of teething
-
constantly putting fingers or
fists in the mouth - babies like to chew on things whether
or not they are teething
-
swollen, or puffy area on gum
-
Teething does not cause
colds, diarrhea, or high fever, but it can make a baby uncomfortable.
If your baby becomes sick around the same time teeth are coming
in, it is important to evaluate the symptoms of that illness independently
of the teething. Call your child's physician for advice if your
baby is sick.
How
Can You Help Your Child With the Discomforts of Teething?
If your baby is cranky
with teething, try giving him/her hard rubber toys, teething rings,
or cold teething toys to chew on. Do not freeze teething toys or
rings as these can hurt your baby's gums. You can also rub your
baby's gum with your finger. Teething gels (i.e., Anbesol®,
Orajel®) are not needed or helpful as they are quickly washed
off with drooling. Something cold on the gums usually soothes and
numbs the gums better. Ask your baby's physician about pain-relieving
medications for teething.
Care
of Baby Teeth
Once your baby gets a
tooth, good dental care should begin. Clean your baby's teeth once
a day with a soft, wet cloth. At 12 months of age, a small, soft
toothbrush with water on it can be used. As your child gets older,
a small dab of toothpaste can be used on the toothbrush. Consult
your child's dentist regarding the best time for your child to begin
using toothpaste.
Do not give your baby
a bottle in bed to fall asleep. If your baby drinks from a bottle
and then falls asleep, milk or juice will stay on the teeth and
cause tooth decay.
Baby teeth are important.
Teeth are needed to chew food and form sounds when talking. Baby
teeth also save space in the mouth for permanent teeth, making it
particularly important to take care of them.
Online
Resources
(Our Organization is not
responsible for the content of Internet sites.)
American
Academy of Pediatrics (AAP)
American
Heart Association
British
Medical Journal
Circulation,
Journal of the American Heart Association
National
Highway Traffic Safety Administration
Pediatrics
|
