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Teething again

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    One of the more frequently quoted aphorisms of the late Professor Ronald Illingworth stated that “teething produces nothing but teeth”. Nevertheless, the belief that teething may produce symptoms such as mild fever, drooling, disturbed sleep, rash, or diarrhoea has been difficult to nail. Now a prospective study in Cleveland, Ohio (Michael L Macknin, and colleagues. Pediatrics2000;105:747–52) has shown that symptoms do increase in the days before and after eruption of a tooth.

     The parents of 125 well children agreed to make daily observations of their children between the ages of 4 months and 1 year, recording 18 different symptoms, twice daily temperature by ear thermometer, and tooth eruptions. They were told that the study was of normal development without emphasis on the effects of teething. There was a period of eight days around tooth eruption (four days before, the day of eruption, and three days after) when some symptoms increased in frequency. These symptoms were increased biting, drooling, gum rubbing, sucking, irritability, wakefulness, ear rubbing, facial rash, poor appetite for solids, and mild temperature elevation. Diarrhoea, vomiting, cough, sleep disturbance, and non-facial rash were not significantly increased.

     Despite these findings it was not possible to define any symptom cluster which reliably predicted tooth eruption. No single symptom was more than 20% more frequent in teething than in non-teething periods. Similarly, there were 2067 child-days of temperature over 100° F but a tooth erupted on only 64 of those days.

     Mild symptoms may be common before, during, and after tooth eruption but they are unreliable predictors of tooth eruption and should not be dismissed as teething symptoms without considering other possibilities.

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