Few things are as heartbreaking (or nerve-wracking) as the sound of an infant crying in pain during teething.
A parent's first impulse is to do something to relieve the pain. But, is that a good idea? Not necessarily.
One thing doctors and other health care professionals agree on is that teething is a normal part of childhood that can be treated without prescription or over-the-counter (OTC) medications.
Too often well-meaning parents, grandparents and caregivers want to soothe a teething baby by rubbing numbing medications on the tot's gums, using potentially harmful drugs instead of safer, non-toxic alternatives.
That's why the Food and Drug Administration (FDA) is warning parents that prescription drugs such as viscous lidocaine are not safe for treating teething in infants or young children, and that they have hurt some children who used those products.
FDA has previously recommended that parents and caregivers not use benzocaine products for children younger than 2 years, except under the advice and supervision of a health care professional. Benzocaine -- which, like viscous lidocaine, is a local anesthetic -- can be found in such OTC products as Anbesol, Hurricaine, Orajel, Baby Orajel, and Orabase.
The use of benzocaine gels and liquids for mouth and gum pain can lead to a rare but serious -- and sometimes fatal -- condition called methemoglobinemia, a disorder in which the amount of oxygen carried through the blood stream is greatly reduced. And children under 2 appear to be at particular risk.
On average, children get one new tooth every month from 6 months of age to about age 3, for a total of 20 "baby teeth."
According to the American Academy of Pediatrics (AAP), occasional symptoms of teething include mild irritability, a low-level fever, drooling and an urge to chew on something hard.
Because teething happens during a time of much change in a baby's life, it is often wrongly blamed for sleep disturbances, decreased appetite, congestion, coughing, vomiting and diarrhea.
If your child's gums are swollen and tender,
- gently rub or massage the gums with your finger, and
- give your child a cool teething ring or a clean, wet, cool washcloth to chew on.
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 object is too cold, it can hurt the gums and your child. The coolness soothes the gums by dulling the nerves, which transmit pain.
"The 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."
Parents should supervise their children so they don't accidentally choke on the teething ring or wash cloth.
For teething, avoid local anesthetics such as viscous lidocaine or benzocaine-containing teething products except under the advice and supervision of a health care professional.
Viscous lidocaine is a prescription medication, a local anesthetic in a gel-like syrup. Doctors may prescribe it for chemotherapy patients (children and adults) who are unable to eat because of mouth ulcers that can occur with chemotherapy. Dentists may use it to reduce the gag reflex in children during dental X-rays and impressions.
Parents may have viscous lidocaine on hand if it has been prescribed to treat another family member for pain relief from conditions such as mouth or throat ulcers. But it should never be used to comfort a teething baby.
A danger to babies
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," says Michael R. Cohen, RPh, MS, ISMP president.
Parents have been known to apply viscous lidocaine repeatedly if a baby keeps fussing, says Cohen. They have also been known to put liquid gel forms of a topical anesthetic into a baby's formula or even soak 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 says. For all these reasons, FDA recommends viscous lidocaine not be used to treat the pain associated with teething.
"Teething is a normal phenomenon; all babies teethe," 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."