Editor—One of the messages of the short report by Wake and Hesketh is that healthcare professionals should be wary of attributing symptoms such as fever and irritability to teething because of the risk of missing significant illness.1 Another seems to be that teething rarely causes any symptoms and that healthcare professionals who believe that it does are misinformed. I think this misrepresents the facts.
At least three or four retrospective studies and three good prospective studies show the association of symptoms with teething. The prospective studies vary in size (Wake et al, 21 infants and 90 eruptions; Jaber et al, 46 infants and 46 tooth eruptions; and Macknin et al, 125 infants and 475 eruptions).2–4 All show significant associations between teething and at least one of the symptoms that were monitored.
The biggest study, with the greatest power, showed associations with biting behaviour, drooling, gum rubbing, irritability, sucking, wakefulness, reduced appetite, and temperature more than one standard deviation above normal. All associations were significant (P=0.01 or less) and for fever above 38.3°C (P=0.001). Altogether 35% of infants had one or more of these symptoms in the period around tooth eruption in comparison with background rates for symptoms on non-teething days in the range of 6-20%.
Parents clearly associate certain symptoms with teething, as is borne out by several studies, including one by Wake et al.5 In my experience, these views are prevalent in Australia, Canada, the United Kingdom, and South Africa. Maybe these parents are misinformed by a global old wives' tale or by an international confidence trick played by teething gel manufacturers, or maybe observations of their own children lead them to these conclusions.
I plump for the last explanation: paediatricians have a long tradition of listening carefully to, and believing, the mothers (and fathers) of their patients. I agree that if a healthcare professional sees an irritable and febrile baby, he or she should be cautious in attributing the symptoms to teething because no specific pattern can reliably differentiate teething symptoms from symptoms of early serious infection.
Given that teething does cause some symptoms, are healthcare professionals wrong if they recommend drug treatment with the intention of alleviating them, as implied by Wake et al? I am unaware of any scientific evidence that guides either way. When evidence is lacking, recommend no treatment or only treatments with a minimal risk of adverse effects.
References
- 1.Wake M, Hesketh K. Teething symptoms: cross sectional survey of five groups of child health professionals. BMJ. 2002;325:814. doi: 10.1136/bmj.325.7368.814. . (12 October.) [DOI] [PMC free article] [PubMed] [Google Scholar]
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- 3.Jaber L, Cohen IJ, Mor A. Fever associated with teething. Arch Dis Child. 1992;67:233–234. doi: 10.1136/adc.67.2.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
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