Can teething cause fever in toddlers?

Teething Does Not Cause Fever in Toddlers

Teething does not cause fever in toddlers, and any fever during teething should be evaluated for other causes to prevent missing serious infections. 1, 2

Evidence on Teething and Fever

Scientific Findings

• Prospective studies show that while mild temperature elevation may occur during teething, significant fever (>102°F/38.9°C) is not associated with teething 2
• When fever occurs during teething, it's essential to evaluate for other causes, particularly infections such as urinary tract infections (UTIs) which are common in young children 3, 4
• A study examining mothers' reports found that while 20 infants had temperatures >37.5°C on the day of tooth eruption, attributing fever solely to teething is dangerous 5

Common Misconceptions

• Despite widespread beliefs among parents and some healthcare providers, research does not support that teething causes significant fever, diarrhea, rashes, seizures, or bronchitis 1
• There are significant differences in beliefs between pediatricians, pediatric dentists, and parents regarding teething symptoms - with pediatricians less likely to attribute symptoms like diarrhea to teething (9.1%) compared to parents (56.7%) and pediatric dentists (52%) 6

Symptoms Actually Associated with Teething

Symptoms that have been scientifically associated with teething include:

• Increased biting and gum-rubbing
• Drooling
• Irritability
• Mild temperature elevation (but not significant fever)
• Facial rash
• Decreased appetite for solid foods
• Wakefulness 2

Clinical Approach to Fever in Teething Toddlers

Assessment Algorithm

1. Measure temperature properly (rectal temperature is gold standard for infants/young children) 4

2. If temperature ≥38°C (100.4°F), consider the following:

   • Age of child (higher risk in younger children)
   • Duration of fever
   • Associated symptoms
   • Presence of other potential sources of infection

3. For children with fever without an obvious source:

   • Consider UTI evaluation, especially in:
     • Girls <24 months
     • Uncircumcised boys <12 months
     • Children with temperature ≥39°C (102.2°F)
     • Children with fever ≥2 days 4

Important Cautions

• Never attribute fever to teething without ruling out other causes
• No teething child in prospective studies had fever ≥104°F or life-threatening illness 2
• Young children with fever without source have 3-7% prevalence of UTI 3
• Response to antipyretic medication does not indicate lower likelihood of serious bacterial infection 4

Bottom Line for Clinicians

When evaluating a febrile toddler who is teething:

• Do not assume teething is causing the fever
• Perform appropriate evaluation based on the child's age and risk factors
• Consider UTI and other infectious causes
• Treat the fever for comfort while pursuing diagnosis
• Educate parents that teething does not cause significant fever

Remember that attributing fever to teething without proper evaluation can lead to missed diagnoses of serious infections, potentially resulting in increased morbidity and mortality.