What is the recommended management for teething pain in a 6-month-old infant?

Management of Teething Pain in a 6-Month-Old Infant

For teething pain in a 6-month-old infant, nonpharmacologic approaches such as chilled teething rings, breastfeeding, and gentle gum massage should be used as first-line treatment, with pharmacologic options reserved only for cases of significant discomfort. 1

Nonpharmacologic Management (First-Line)

• Cold teething rings or clean, cold washcloths can be offered to the infant to chew on, as the cold temperature helps reduce inflammation and provides counter-pressure against the erupting tooth 2
• Breastfeeding during teething episodes has been shown to decrease pain responses in infants and provides comfort through both nutritional and non-nutritional sucking 1
• Nonnutritive sucking on a pacifier can have analgesic effects and contributes to calming the infant during teething discomfort 1
• Gentle gum massage with a clean finger can provide temporary relief from teething pain 2
• Skin-to-skin contact between infant and mother during teething episodes can decrease pain behaviors 1

Pharmacologic Management (Second-Line)

Only if nonpharmacologic measures are insufficient:

• Acetaminophen can be used for short-term pain management when teething pain is significant enough to interfere with feeding, sleeping, or normal activity 1
  • Use appropriate weight-based dosing and follow package instructions carefully
  • Avoid prolonged use without medical supervision

Cautions and Contraindications

• Benzocaine-containing products (often marketed for teething) should be avoided in infants under 2 years of age due to the risk of methemoglobinemia, which can be potentially fatal 3, 4
  • Despite FDA warnings, many pharmacists still inappropriately recommend benzocaine products for infant teething 4
• Lidocaine-based teething gels are not recommended due to risks of toxicity including seizures, respiratory arrest, and potential death 5
• Homeopathic teething products have insufficient evidence to support their safety and efficacy 6

Signs and Symptoms of Teething

Common symptoms that may accompany teething include:

• Sensitive and painful gums 2
• Increased drooling 2
• Irritability and crying 2
• Feeding difficulties 2
• Sleep disturbances 2

Special Considerations

• Teething typically begins around 6 months of age, with the lower central incisors usually erupting first 1, 2
• Fever, diarrhea, and significant illness are NOT normal symptoms of teething and should prompt evaluation for other causes 2
• If symptoms are severe or accompanied by fever >100.4°F, seek medical attention to rule out other conditions 2

Monitoring and Follow-up

• Monitor for signs of relief after implementing management strategies
• If symptoms persist or worsen despite appropriate management, consult with the child's pediatrician to rule out other causes of discomfort 2
• Be vigilant for signs of dental complications such as gingival swelling or discoloration that may require dental evaluation 1

Teething is a normal developmental process, but it can cause significant discomfort for some infants. Using nonpharmacologic approaches as first-line treatment minimizes risks while effectively managing symptoms in most cases.