Wednesday, August 3, 2016

Those several sleepless weeks did not have anything to do with teething because the emergence of a tooth does not take that long.

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.”

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