‘It's just teething….’

Paediatricians are rightly cautious when carers attribute what might be significant symptoms in infants to ‘just teething’: we can all remember infants whose ‘teething’ fever turned out to be meningitis. But what symptoms does the eruption of primary dentition actually cause? A meta-analysis tried to summarise all the available literature (Massignan C, et al. Pediatrics 2016. doi:10.1542/peds.2015-3501). Interestingly the only cited previous review on this was in our own Archimedes (Tighe M. 2007. doi:10.1136/adc.2006.110114). The Pediatrics review found 16 appropriate studies looking at symptoms and signs occurring during teething from 0 to 36 months. The studies differed greatly in their methods of ascertainment and objectivity. Some relied on parental recall. Overall about 70% of infants had symptoms of some sort, the most common being gum irritation (87%), irritability (68%) and drooling (56%). Younger infants tended to have the most symptoms. Diarrhoea, vomiting and rashes do not appear to be strongly associated.

Only 3 studies actually gathered daily temperature measurements: temperature differences between eruption and non-eruption days were between zero and 0.7°C, and the highest (rectal) temperature reported was 37.8°C. Thus we can be confident that fevers of 38°C and above …