Can teething cause fever?

Teething and Fever: Evidence-Based Assessment

Teething does not cause significant fever (≥38°C/100.4°F), and any fever in a teething infant should prompt evaluation for other causes of illness.

Understanding Teething and Associated Symptoms

Teething is a normal developmental process that occurs when primary teeth emerge through the gums. While many symptoms are commonly attributed to teething, the scientific evidence does not support most of these associations:

Symptoms that MAY be associated with teething:

• Mild temperature elevation (but not significant fever)
• Increased biting and gum rubbing
• Drooling
• Irritability
• Mild daytime restlessness
• Temporary decreased appetite for solid foods
• Facial rash

Symptoms NOT associated with teething:

• Significant fever (≥38°C/100.4°F)
• Diarrhea
• Vomiting
• Cough
• Congestion
• Rashes other than facial rashes
• Serious illness

Evidence on Teething and Fever

The scientific evidence consistently shows that teething is not a cause of significant fever:

• A prospective cohort study of 125 children found that while mild temperature elevation may occur during teething, no child had a fever over 102°F, and no teething child had a life-threatening illness 1.

• Another cohort study of 21 children found no significant difference in temperatures between "tooth days" and "non-tooth days," with no association between teething and fever 2.

• A study examining 46 healthy infants found that while some infants had temperatures above 37.5°C on the day of tooth eruption, the researchers emphasized the danger of attributing fever to teething 3.

• A study of 597 infants reported that fever (≥38°C) was reported in only 15.2% of teething infants 4.

Clinical Implications

When evaluating a febrile infant:

1. Never assume fever is due to teething - Fever (≥38°C/100.4°F) should always prompt evaluation for other causes

2. Consider common causes of fever in infants:

   • Viral infections (most common)
   • Otitis media
   • Urinary tract infections (especially in children <1 year) 5
   • Respiratory infections

3. Evaluate based on age and clinical presentation:

   • For infants <1 year with fever without source, consider risk for urinary tract infection 5
   • Persistent fever (≥10 days) without improvement suggests possible bacterial infection 6
   • High fever (≥39°C) with specific symptoms may warrant additional testing 6

Management Recommendations

1. For teething discomfort without fever:

   • Gum massage
   • Cold teething rings
   • Over-the-counter pain relievers (acetaminophen, ibuprofen) if needed for comfort
   • Topical gingival treatments may provide relief 4

2. For infants with fever:

   • Conduct appropriate evaluation based on age and clinical presentation
   • Provide antipyretics for comfort (acetaminophen, ibuprofen)
   • Monitor for signs of dehydration and respiratory distress 6
   • Encourage oral fluids in small, frequent amounts 6

Common Pitfalls to Avoid

1. Attributing fever to teething - This can lead to delayed diagnosis of serious conditions

2. Overuse of medications - Using systemic medications to treat normal teething when non-pharmacological approaches may be sufficient

3. Failure to evaluate fever - Any temperature ≥38°C (100.4°F) should prompt appropriate clinical evaluation, especially in infants

4. Ignoring parental concerns - While parents often attribute many symptoms to teething, their observations of changes in their child's behavior should be taken seriously and evaluated appropriately

Remember that while teething may cause mild discomfort and irritability, significant fever or illness should never be dismissed as "just teething" and warrants proper medical evaluation.