What is the best way to manage an infant's teething pain and prevent scratching?

Managing Infant Teething Pain and Preventing Scratching

For teething infants who are pulling and scratching, prioritize non-pharmacological interventions like cold teething rings and gentle gum massage, while keeping nails trimmed short and considering soft mittens to prevent skin trauma.

Immediate Scratch Prevention Strategies

• Trim fingernails frequently to minimize the damage from scratching, as infants with oral discomfort often rub their faces and mouths 1
• Consider soft cotton mittens during periods of intense discomfort to physically prevent scratching while allowing normal hand movement 1
• Keep the infant dressed and wrapped appropriately to reduce friction-related trauma from excessive movement, though ensure this doesn't cause overheating 2

First-Line Pain Management

Non-pharmacological approaches should be your primary strategy:

• Provide cold teething rings that have been refrigerated (not frozen) to soothe inflamed gums effectively 1, 3
• Apply gentle counter-pressure by massaging gums with a clean finger or soft cloth 1
• Offer cold, soft foods if the infant has started solids, which can provide relief through temperature and pressure 1

Pharmacological Options (Use Cautiously)

Avoid lidocaine-based teething gels entirely - they pose serious risks including seizures, respiratory arrest, and death in infants, with limited evidence of efficacy 4. The American Academy of Pediatrics and Australian/New Zealand Society of Paediatric Dentistry do not recommend topical anesthetic agents for teething 4.

If pain management is necessary:

• Consider hyaluronic acid-based gels which have shown efficacy in reducing crying, irritability, gum redness, and salivation without the toxicity risks of anesthetic gels 5, 3
• Systemic acetaminophen/paracetamol may be used for severe discomfort, following age-appropriate dosing guidelines 2

Common Pitfalls to Avoid

Critical safety concerns:

• Never use choline salicylate gels despite their historical use, as salicylates pose Reye's syndrome risk 1
• Avoid compounded pharmacy preparations containing lidocaine, which have variable concentrations and increased toxicity risk 4
• Don't misattribute serious illness to teething - fever above 38°C, persistent crying, or systemic symptoms warrant medical evaluation for other causes 6

Monitoring and Red Flags

Watch for signs requiring medical attention:

• Excessive drooling with skin breakdown around the mouth or chin 1
• Self-inflicted scratches becoming infected - look for increased redness, warmth, or purulent drainage 2
• Feeding refusal lasting more than 24 hours 1
• Symptoms persisting beyond what's expected for normal teething (typically resolves within days of tooth eruption) 1, 3

Parental Education Points

• Reassure parents that teething is self-limited and symptoms typically improve within days of tooth emergence 1
• Explain that scratching behavior often reflects the infant's attempt to relieve oral discomfort by rubbing their face 1
• Emphasize the very low certainty of evidence for most teething treatments, making safety the paramount concern 3