Parents’ and medical personnel's beliefs about infant teething

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Abstract

Many symptoms are attributed to teething. Little evidence exists to support these beliefs, despite their implications on clinical management. This study attempted to investigate parental and medical personnel's beliefs about teething. The study was conducted by means of a questionnaire, submitted to 55 pediatricians and 130 nurses. A parent survey was conducted simultaneously. We evaluated 462 questionnaires. An association of teeth eruption with infant morbidity was believed to exist by 76% of the responders, mostly by parents and nurses, and less so by physicians. Irritability, fever, and loose stools/diarrhea were believed to be the most common symptoms associated to teeth eruption. We conclude that almost all parents, the majority of nurses, and many physicians believe that teething is associated with the appearance of symptoms, most of which are minor and relate to discomfort rather than physical illness, but a substantial minority still ascribes potentially serious symptoms to teething.

Introduction

The effects of teething on infant health have been debated for ages, and traditional beliefs on the issue have still not been entirely supplanted by scientific findings. A child's first tooth usually erupts between 4 and 10 months of age, and the full complement of 20 deciduous teeth is almost always present by 30 months [1]. Thus, on average, roughly one tooth erupts per month between 6 and 30 months of age, closely coinciding with a period during which infants are known to experience frequent minor illnesses and rapid developmental change. Probably because of this temporal association, causal attribution of signs and symptoms of illness to teething appears to be nearly universal across cultures and continents.

Many symptoms are attributed to teething in infancy. Some, such as irritability, drooling, mouthing, and sleep disturbance, may seem trivial, but are very significant for the child and parents; others, such as fever, diarrhea, ear infection and susceptibility to infections, may have far more serious implications [2]. Surveys of parents [3], pediatricians [4], [5], [6], and other child health professionals [6], [7] reveal, that beliefs on teething symptoms are common and stable over time, and are similar across all groups studied. In contrast, academic publications [8], [9], [10], [11], [12] tend to take the view that teething causes few, if any, symptoms and that no serious illness should ever be ascribed to teeth eruption.

In a prospective study, Jaber et al. suggested a rise in mean daily temperature of 0.5 °C in the 3 days leading up to the eruption of the first tooth, as observed by parents [13]. The near universal belief that teething is related to diarrhea was mentioned by Coreil et al. [5]. Many Australian parents believe that teething causes a large variety of symptoms in young children, even when such symptoms may be indicative of other serious conditions [2]. In this study, we report a recent survey of teething beliefs among parents with infants aged 6–24 months, child health nurses and pediatricians in Israel.

Section snippets

Methods

The study was conducted in an urban area in central Israel. A written questionnaire was mailed in May 1999 to 55 pediatricians and 130 child health nurses, who were randomly selected from state registers held by the relevant professional bodies. A parent survey on teething was conducted simultaneously. Parents, from a middle class, educated population, attending a community pediatric medical center with their children for various health problems, completed the questionnaire.

The questionnaire

Results

Forty-five physicians (81.8%), 108 child health nurses (83.1%), and 309 parents completed the questionnaire, totaling 462 questionnaires for evaluation. Three hundred and fifty-one (76%) of the responders believed that teeth eruption is associated with infant morbidity, 236 of the parents (76.4%), 90 of the nurses (83.3%), and 25 of the physicians (55.5%) (Table 1). Significantly more nurses and parents, as compared to physicians, considered this association to exist (P < 0.0001). No

Discussion and conclusion

Teething is uncomfortable and painful for most infants and a very distressing experience for parents. Immediately prior to teeth eruption, the gums swell up and are tender to palpation. Infants become irritable and restless, and drool excessively. They try to find relief from their pain by applying pressure on the gums, chewing their fingers and biting on anything at hand. The results of this survey demonstrate that most Israeli parents believe that teething causes symptoms and expect their

Acknowledgments

We wish to thank Dr. Monica Finkelstein and Dr. Ruth Shenhav for their invaluable cooperation. Our gratitude is also extended to all the nurses in the Pediatric Ambulatory Medical Center in Petah Tikva, and to Mrs. Rivka Gal in particular. We also thank Dorit Karsh from the Department of Information and Statistics at Kupat-Holim Klalit, for the statistical analysis.

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