What is the recommended treatment for an 8-month-old infant with teething symptoms?

Teething in an 8-Month-Old Infant

Assessment and Diagnosis

Teething is a normal physiological process that should be diagnosed primarily by palpable or visible tooth eruption, not by symptoms alone, as most symptoms attributed to teething are minor and self-limiting. 1, 2

Clinical Examination

• Palpate the gums to feel for emerging teeth or visible tooth eruption—this is the definitive diagnostic criterion, not symptom-based diagnosis 3
• Examine for localized gum inflammation including erythema, swelling, and tenderness at eruption sites 4, 1
• Rule out systemic illness immediately—fever >38.9°C (102°F), severe distress, lethargy, persistent vomiting, diarrhea, or rash require urgent medical evaluation as these are NOT caused by teething 1, 2

Key Diagnostic Pitfall

The most dangerous error is attributing serious systemic symptoms to teething and delaying appropriate treatment of a potentially life-threatening illness. 1, 2 Parents diagnose teething more by symptoms (65%) than by actual tooth presence (36-43%), leading to misdiagnosis. 3

Symptoms Actually Associated with Teething

Localized symptoms only:

• Sensitive, painful gums at eruption sites 4
• Increased drooling 4, 3
• Mouthing/biting behaviors 3
• Mild irritability and sleep disturbance 4, 3
• Feeding difficulties due to gum discomfort 4

NOT caused by teething: High fever, systemic infections, severe diarrhea, convulsions, or significant systemic illness 1, 2

Treatment Algorithm

Step 1: Non-Pharmacological Management (First-Line)

Start with simple mechanical interventions before any medication:

• Cold teething rings provide effective symptomatic relief through counter-pressure and cooling effect 4, 1
• Gentle gum massage with clean finger 1
• Soft diet if feeding difficulties present 4

Step 2: Pharmacological Intervention (If Non-Pharmacological Measures Insufficient)

For persistent pain and distress:

• Systemic analgesia with acetaminophen (paracetamol) is the preferred pharmacological option, used by 60% of parents 3
• Topical analgesic/anesthetic gels (55% usage rate) can be applied directly to affected gums for localized pain relief 4, 3
• Hyaluronic acid-based gels have demonstrated efficacy in reducing cry, irritability, inappetence, salivation, and gum redness (P<0.01) with favorable safety profile 5

Step 3: Parental Education and Reassurance

Provide specific information:

• Teething is self-limiting and normal—average onset at 6 months with completion by age 3 years 4
• Symptoms should be mild and localized to the gums 1, 2
• Duration per tooth varies but symptoms should not be prolonged 3

Step 4: Safety-Netting

Instruct parents to seek immediate medical attention if:

• Child becomes systemically unwell with high fever, lethargy, or severe distress 1
• Symptoms persist beyond expected teething timeline 1
• Any concerning systemic symptoms develop 1, 2

Critical Clinical Caveat

Never dismiss systemic symptoms as "just teething." The historical practice of attributing severe illness to teething has led to delayed diagnosis of serious conditions for over 5,000 years. 2 If an infant presents with fever, significant distress, or systemic symptoms, refer for urgent medical evaluation to exclude serious pathology—teething does not cause these symptoms. 1, 2