Management of Teething Pain in a 5-Month-Old Infant
Start with nonpharmacologic measures as first-line management, including breastfeeding during teething episodes, nonnutritive sucking on a pacifier, and skin-to-skin contact, reserving acetaminophen for significant pain that interferes with feeding, sleeping, or normal activity. 1
First-Line: Nonpharmacologic Interventions
These strategies should be implemented before considering any medications:
Breastfeeding during teething episodes has demonstrated effectiveness in decreasing pain responses in infants through both nutritional and non-nutritional sucking mechanisms 2, 1
Nonnutritive sucking on a pacifier provides analgesic effects and helps calm the infant during teething discomfort 2, 1
Skin-to-skin contact (kangaroo care) between infant and parent decreases pain behaviors and stress responses 2, 1
Cold teething rings can be applied to sensitive gums to provide localized relief 3
Gentle gum rubbing has been shown to ease discomfort and is preferred over medication use by informed parents 4
Second-Line: Pharmacologic Management
Reserve medications for when nonpharmacologic measures are insufficient:
Acetaminophen (paracetamol) can be used for short-term pain management when teething pain significantly interferes with feeding, sleeping, or normal activity 2, 1
Dosing must be weight-based following package instructions carefully, and should not be used for prolonged periods without medical supervision 1
Avoid prolonged or routine use of acetaminophen for teething, as it should be reserved for significant discomfort only 1
Important Safety Considerations
Common pitfall: Parents and healthcare providers historically have attributed severe systemic symptoms (high fever, significant illness) to teething, which can delay diagnosis of serious conditions 5, 6. At 5 months of age, teething may be just beginning or not yet started, as the typical onset is around 6 months 1, 3.
Do not dismiss systemic illness as "just teething" - fever above 38.5°C, persistent crying, lethargy, or other concerning symptoms require medical evaluation for alternative diagnoses 5, 6
Avoid topical anesthetic gels (such as those containing benzocaine or lidocaine) in infants, as these carry risks and their use should be minimized 4
Teething is a normal, self-limiting physiological process that does not cause severe systemic illness 5, 6
Parental Education and Monitoring
Provide reassurance that teething is normal and self-limiting, with symptoms typically including localized gum sensitivity, increased drooling, and mild irritability 3, 5
Monitor for signs of relief after implementing management strategies 1
Safety-netting advice: Instruct parents to seek medical attention if the child becomes systemically unwell, has prolonged symptoms beyond what is expected for teething, or is in severe distress 5
Gingival swelling or discoloration may require dental evaluation if persistent 1