What are the available treatments to soothe teething discomfort in infants?

Treatments for Teething Infants

Non-pharmacological methods like teething rings, cold washcloths, and gentle gum massage should be used as first-line treatments for teething infants, with pharmacological options reserved for cases of significant discomfort.

Understanding Teething

Teething is a normal physiological process that typically begins around 6 months of age, with most children having all 20 primary teeth by age 3 years 1. The process can cause discomfort in infants, leading to symptoms such as:

• Sensitive and painful gums
• Irritability
• Drooling
• Feeding difficulties
• Sleep disturbances
• Crying

Treatment Algorithm

Step 1: Non-pharmacological Approaches (First-line)

These methods are safe, effective, and should be tried before any medication:

• Cold therapy:

  • Chilled (not frozen) teething rings
  • Clean, cold washcloth for the infant to chew on
  • Cold foods for older infants who have started solids

• Physical comfort measures:

  • Gentle gum massage with clean finger
  • Distraction techniques (playing, reading, cuddling)
  • Nonnutritive sucking (pacifier)

• Behavioral interventions:

  • Swaddling and positioning for comfort 2
  • Skin-to-skin contact with parent
  • Breastfeeding during periods of discomfort 2

Step 2: Pharmacological Approaches (Second-line)

Only if non-pharmacological methods are insufficient:

• Topical agents:

  • Benzocaine gels (only for children 2 years and older) 3
  • Hyaluronic acid-based gels (shown to reduce gum inflammation) 4

• Systemic analgesics (for significant discomfort):

  • Acetaminophen or ibuprofen at age-appropriate doses 2
  • Should be given on a regular schedule for persistent pain
  • May alternate medications as recommended by healthcare provider 2

Important Considerations

Safety Concerns

• Avoid benzocaine products in children under 2 years due to risk of methemoglobinemia 2, 3
• Never use alcohol-containing products on an infant's gums
• Avoid homeopathic teething tablets due to inconsistent formulations and limited evidence
• Avoid teething necklaces due to choking and strangulation hazards

When to Seek Medical Attention

Parents should contact a healthcare provider if:

• Child has persistent high fever (>101°F)
• Severe distress or inconsolable crying
• Refusal to eat or drink for extended periods
• Symptoms persist beyond 2 weeks 2
• Significant sleep disturbance affecting development

Evidence Quality

The evidence for teething treatments is generally of low to moderate quality 5. Most recommendations are based on clinical experience and expert consensus rather than high-quality randomized controlled trials. Non-pharmacological approaches have the strongest safety profile and should be prioritized.

Common Pitfalls to Avoid

1. Attributing systemic symptoms to teething: Fever >101°F, diarrhea, or significant illness should not be dismissed as "just teething" and require medical evaluation
2. Overuse of topical anesthetics: Can lead to toxicity if used too frequently
3. Relying on unproven remedies: Many traditional remedies lack evidence and may pose safety risks
4. Delaying dental care: The American Academy of Pediatric Dentistry recommends establishing a dental home within 6 months of first tooth eruption 1

By following this approach, most teething discomfort can be managed effectively while ensuring infant safety and comfort.