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Teething Can Gum Up the Right Diagnosis

Symptoms may signal more serious problems

FRIDAY, Oct. 11, 2002 (HealthDayNews) -- 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However, an Australian survey of doctors and nurses found that many still adhere to an outdated notion that teething can lead to a variety of ills.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 doctors blamed a variety of symptoms on teething, from severe fevers to even death, says Steinberg, a spokesman for the American Academy of Pediatrics.

But in the last couple of decades, doctors 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 tomorrow's 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 -- like Phenobarbital -- by teething infants, although painkillers like 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."

What To Do

Learn more about teething from the American Academy of Pediatrics or KidsHealth.

SOURCES: Joel Steinberg, M.D., pediatrician, University of Texas Southwestern Medical Center, Dallas; Dennis A. Clements, M.D., chief, primary child care, Duke University, Durham, N.C.; Oct. 12, 2002, British Medical Journal
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