Can teething cause hyperthermia (fever) in an infant?

Teething Does Not Cause High Fever (102°F) in Infants

Teething is not associated with high fevers of 102°F (39°C) in infants, and such temperatures should prompt evaluation for other causes of fever. 1, 2, 3

Understanding Teething and Fever

Teething may be associated with mild symptoms, but research has consistently shown that high fevers are not a normal part of the teething process:

• A large prospective study found that while mild temperature elevation may occur during teething, fever over 102°F (39°C) was not significantly associated with tooth emergence 1
• Another study examining 90 teeth eruptions found no significant difference in temperatures between teething days and non-teething days 3
• Research specifically examining the relationship between teething and fever found no strong association 2

Symptoms Actually Associated with Teething

Teething may cause:

• Increased biting and gum-rubbing
• Drooling
• Irritability
• Mild wakefulness
• Decreased appetite for solid foods
• Mild temperature elevation (but not high fever)
• Facial rash
• Ear-rubbing 1

Symptoms NOT Associated with Teething

The following symptoms should not be attributed to teething:

• Fever over 102°F (39°C)
• Congestion
• Vomiting
• Significant sleep disturbance
• Cough
• Non-facial rashes 1

Management of Febrile Infants

When an infant presents with a temperature of 102°F (39°C):

1. Consider age-based risk:

   • Infants under 2 months with any fever (≥38°C/100.4°F) require comprehensive evaluation for bacterial disease 4
   • Infants 2-24 months with fever ≥39°C (102.2°F) may need evaluation based on risk factors 5

2. Evaluate for urinary tract infection:

   • Females younger than 12 months
   • Uncircumcised males
   • Non-black race
   • Fever duration >24 hours
   • Higher fever (≥39°C)
   • No obvious source of infection 5

3. Consider other common causes:

   • Viral infections (most common)
   • Otitis media
   • Respiratory infections 5

Important Cautions

• Danger of misattribution: Attributing a high fever to teething may lead to delayed diagnosis of serious conditions 2
• Parent education: Many parents incorrectly believe that high fevers are caused by teething, which can lead to inappropriate management 3
• Temperature monitoring: Use appropriate temperature measurement methods - rectal temperature is the gold standard for infants 6

Treatment Approach

1. For fever ≥38°C (100.4°F), acetaminophen (Panadol) 15 mg/kg can be used for comfort 6
2. Ensure adequate hydration
3. Monitor for signs of serious illness:
   • Breathing difficulties
   • Severe earache
   • Vomiting >24 hours
   • Drowsiness 6
4. For teething discomfort (without fever):
   • Gentle gum massage
   • Cold teething rings
   • Age-appropriate pain relievers if needed

Remember that while teething may cause mild discomfort and irritability, a temperature of 102°F requires evaluation for other causes and should never be dismissed as "just teething."