Your baby is teething: what to expect and what to do

Teething in an infant is a very exciting moment in the life of the baby and his parents. And although teething is a physiological process, almost all children experience discomfort and anxiety during this period. From the point of view of a scientific approach to this problem, the difficulty lies in the fact that with all the variety of teething symptoms from mild restlessness and moodiness, increased salivation to an increase in body temperature to high numbers and signs of impaired digestion, increased colic and diarrhea, there are no sufficient diagnostic criteria to connect all these numerous symptoms to the root cause. Nevertheless, many parents and some practicing pediatricians are still ready to blame the baby’s teething for almost all the troubles that befall them in the period from 5 - 6 months to one and a half - two years, when the teething process is mainly teeth should already be completed.

Most children begin teething between the ages of 4 and 7 months. As a rule, the eruption of each tooth lasts from 2 - 3 to 8 days. During this time, it is possible to increase body temperature to 37.4 - 38.0 degrees. At the same time, high temperature (from 38.0 and above) usually lasts no more than 2 days. Nasal discharge during the period when teeth are erupting is usually transparent, liquid, and should not contain pathological impurities: pus, greens, etc. Cough during teething is caused by saliva entering the nasopharynx and larynx area, which is released in large quantities. Cough due to teething does not require treatment. Regarding diarrhea, pediatricians sometimes differ in their opinions: some believe that diarrhea (loose stool) is not directly related to teething. And yet, studies have shown that from 10 to 30% of children have frequent and/or loose stools during teething. This is also explained by the large amount of saliva secreted, which enhances intestinal motility.

Teething or infectious disease

However, most modern pediatricians agree that such symptoms in an infant as: long-term, over 2-3 days diarrhea, cough, vomiting, fever (increase in body temperature above 38.5 degrees) are most often caused by infection, and not just teething teeth. Therefore, with any of the above symptoms, it is necessary to examine the child by a pediatrician, and only after other causes of increased body temperature have been excluded, efforts should be concentrated on helping the baby to reduce the discomfort from teething.

Is the rash associated specifically with teething?

The answer is yes, it happens. As a rule, during this period, the baby is very excited, the inflamed areas of the gums are very itchy, the child does not find a place for himself and his body responds to this severe stress with a decrease in immunity and a deterioration in the general condition of the body. Therefore, if you see that there is a rash on your child’s body, then to find out for sure whether it could be as a result of teething or is it a response to some allergenic component or microbial infection, you need to visit a doctor. The doctor will examine the child, conduct diagnostic procedures and, if treatment is necessary, prescribe it. But if the doctor does not find any other problems other than a reaction to teething, then this is not a reason to think that the rash is not serious.

Teething: how to help your baby

This may require a fair amount of patience. During such a difficult period, you should take the baby in your arms more often, caress him, distract him from unpleasant sensations with toys, turn on pleasant, soothing music, and you can sing if natural abilities allow. A walk in the fresh air can also have a calming effect. Children who are breastfed, during teething, begin to cry more often and ask for the breast, and a loving mother needs to be patient, putting the baby to the breast every time, even if he grabs the nipple areola harder than usual during feeding. To satisfy the child’s need to chew something and hold something in his mouth, you can naturally use special rubber rings or toys, so-called teethers. You can offer your child dry food or baby cookies.

Currently, pharmaceutical companies offer a wide range of different products, primarily in the form of gels to “soothe the gums.” In general, most of these products contain painkillers such as lidocaine. You should not abuse these funds. They are not completely harmless; the anesthetics they contain can have an adverse effect on the child’s nervous and cardiovascular systems, and most importantly, they can cause serious allergic symptoms and contribute to the exacerbation of atopic dermatitis (diathesis) in children prone to allergies. In connection with the above, I can recommend, to reduce swelling and inflammation of the gums during teething, such special dental anti-inflammatory drugs for topical use as Cholisal gel, which can be applied to the baby’s gums 2-3 times a day, but must be rubbed in (not too much). of course) with light massaging movements over the entire surface of the gums, and not just putting it in the child’s mouth.

In addition, you can give a child suffering from teething special homeopathic drops, for example Dantinorm baby, according to the instructions for the drug. In any case, if the disturbing symptoms described above in this article appear, I advise you to play it safe once again and call a pediatrician to the home of a child with a high fever. A professional should give his diagnosis and recommendations.

What kind of rash occurs and why does it occur?

A rash on a child’s body can appear for many reasons, not just when teething; it may also be that the parents simply gave the baby new complementary foods or he became infected with something. You need to make sure that the child is completely healthy and there are no allergenic substances around him, for example, low-quality household chemicals or food. Any of these factors can cause a child to develop a rash on any part of the body. It may appear as redness, be hard or flaky to the touch, itch or sting when touched, and may appear as clusters of pimples or blisters. In any of these cases, the first step is to visit a pediatrician.

If the rash is still not associated with any factors other than teething, you must first determine the location of its main location before moving on to treatment.

Where does the teething rash appear and can it spread beyond the baby's face?

As a rule, such a rash, which can be attributed to teething, begins in the area of ​​the child’s head (face) and neck and looks like in the photo. It spreads in stages, from the place of first localization to more distant places on the body. The next stage is usually the arms, and then the rest of the body and legs. The rash itself feels like a very dry area, sometimes flaking, with increased skin temperature at the site of the rash. In any case, no matter what the rash looks like, it should always be under the careful supervision of parents.

If you notice a rash on your child’s face and are sure that he is absolutely not sick with anything, you should visit a doctor and consult with him what needs to be changed in the child’s routine so that the rash disappears.

Teething in children: modern concepts

The eruption of baby teeth in children is a routine process that no individual can avoid. This process is determined by both genetic and environmental factors. Theoretically, innervation-induced pressure in the apical part of the teeth induces the process of eruption, which requires long-term adaptation from the periodontal membrane, as well as active movement of the crown follicle, which destroys the overlying bone tissue.

For many years, discussions have continued among representatives of pediatric specialties regarding teething and its impact on the health of infants [1–3]. Therefore, it was even proposed to consider the so-called “teething syndrome in infants,” which has a corresponding reflection in the International Classification of Diseases, 10th revision - ICD-10 (code K00.7) [2]. Apparently, in the coming years it will find its place in ICD-11.

The opinion of the medical community on the issue of the use of special gels that alleviate the main symptoms that often accompany teething, which will be discussed below, seems equally ambiguous.

The appearance of teeth: just the facts

The formation of teeth occurs approximately on the 40th day of embryonic life. The eruption of primary teeth most often occurs in the second half of the first year of life, usually at the age of 6–8 months.

The order of teething in the first year of life is as follows:

• lower middle incisors;
• upper middle incisors;
• upper lateral incisors;
• lower lateral incisors.

In the latest (20th) edition of the Nelson Textbook of Pediatrics, N. Tinanoff (2016) provides the following information about baby teeth:

• lower middle incisors: first signs of calcification (SCC) - 4.5 months of intrauterine development, crown formation (FC) - 4 months, eruption (E) - 6.5 months;
• upper middle incisors: PPK - 3–4 months of intrauterine development, FC - 4 months, P - 7.5 months;
• upper lateral incisors: PPK - 4.5 months of intrauterine development, FC - 5 months, P - 8 months;
• lower lateral incisors: PPK - 4.5 months of intrauterine development, FC - 4¼ months, P - 7 months;
• lower canines: PPK - 5 months of intrauterine development, FC - 9 months, P - 16–20 months;
• upper canines: PPK - 5.5 months of intrauterine development, FC - 9 months, P - 16–20 months;
• first upper molar: PPK - 5 months of intrauterine development, FC - 6 months, P - 12–16 months;
• first lower molar: PPK - 5 months of intrauterine development, FC - 6 months, P - 12–16 months;
• second upper molar: PPK - 6 months of intrauterine development, FC - 10-12 months, P - 20-30 months;
• second lower molar: PPK - 6 months of intrauterine development, FC - 10-12 months, P - 20-30 months [1].

It is quite natural that the timing and order of teething may differ significantly from those given above (the individual characteristics of this process are often genetically determined). To a certain extent, the timing of teething depends on the gender of the child; in girls it usually occurs somewhat earlier and faster.

According to the proposal of A.F. Tour, to calculate the number of baby teeth that a child aged 6–24 months should have, it is necessary to subtract the number 4 from the number of months of life (actual calendar age) [4].

Currently, it is believed that in the process of teething, it is not so much direct perforation of the gum mucosa by crowns that occurs, but rather an increased production of certain hormones in the child’s body, which cause cell death in the gums, freeing up space for teeth.

The review work by I. Kjær (2014) outlines modern ideas about the mechanisms of the process of primary teething in children, and also presents the author’s own hypothesis, according to which the described physiological process depends on three main factors:

• free space in the path of teething;
• lift or pressure from below;
• adaptability (adaptability) of teeth in the periodental membrane [5].

In general, among the many theories and hypotheses (there are about 500 in total) explaining the mechanisms of teething, only four deserve attention: 1) growth of the tooth root; 2) increased hydrostatic pressure in the periapical zone or dental pulp; 3) reconstruction of bone tissue; 4) periodontal traction [6].

In the Russian Federation, explanations for the mechanisms of teething are usually found in the theories of John Hunter (“root” theory), G. V. Yasvoin (“rocket” theory) and A. Ya. Katz (the theory of pressure of a growing tooth on the side walls of the alveoli), as well as I. G. Lukomsky (theory of simultaneous development of tooth and alveolar bone), which readers can familiarize themselves with if they wish.

The crown follicle destroys the overlying bone tissue and thus provides the necessary space along the teething route. This process depends on the state of the ectoderm in the tooth follicle.

The root shield acts as a glandular membrane, the innervation of which creates excess pressure that forces the teeth towards the surface of the shield, periodontal membrane and pulp tissue. As a result of this pressure, the teeth rise in the direction of eruption.

Problematic teething

On the one hand, many pediatricians believe that the teething process does not cause fever or diarrhea. On the other hand, tens to hundreds of articles report hypothermia accompanying teething, bowel disorders and many other symptoms accompanying this physiological process. In general, the medical community recognizes that teething can be accompanied by pain and increased body temperature (hyperthermia) [1].

The so-called “difficult teething” (dentitio difficilis) may be accompanied by local symptoms (swelling/redness/itching of the gums), general malaise, loss of appetite, hypersalivation, rhinorrhea, restlessness and irritability, nausea, regurgitation/vomiting, sleep disturbances, increased body temperature , dyspeptic symptoms, skin rashes, delay or slowdown in weight gain, etc. [7–10].

As indicated by A.L. Zaplatnikov et al. (2018), a key role in the development of various teething symptoms belongs to pro-inflammatory cytokines (in the gingival fluid during primary teething, the concentration of interleukin-1, interleukin-2 and interleukin-8, as well as tumor necrosis factor α, increases) [2].

The presence of symptoms such as hyperthermia, sialorrhea/hypersalivation, sleep disturbances and irritability in children during the first years of life during teething is confirmed by the work of M. Memarpour et al. (2015), S. Massignan et al. (2016), and M. A. Nemezio et al. (2017), and the last two publications used tools and approaches of evidence-based medicine - a systematic review and meta-analysis [11–13].

Since it has been repeatedly demonstrated over the years that the eruption of primary teeth can be problematic and accompanied by pathological manifestations, there is no doubt about the need to treat these symptoms. For this purpose, paracetamol and ibuprofen (oral or rectal dosage forms), some systemic homeopathic remedies (Viburkol, etc.), as well as special children's gels for gums during teething can be used [14–17].

The most convenient to use are topical gels, which are widely used in many countries around the world.

Teething Gels: Possible Ingredients

Currently, about a dozen products for this purpose are simultaneously presented in the pharmacy network of the Russian Federation. If we try to symbolically classify all the currently available gels for gums during teething, then they can be conditionally classified into one of three categories:

1) synthetic gels (with analgesics/anaesthetics); 2) gels based on natural plant extracts; 3) combined gels: synthetic anesthetics combined with natural plant extracts.

The anesthetics in the described gels are most often lidocaine, benzocaine and/or choline salicylate.

Among the antiseptic ingredients of the gels are cetylpyridinium chloride and cetalkonium chloride.

Other components that may be used are polidocanol (a non-ionic detergent) and trometamol (an anti-acidemic agent); these pharmacological agents provide a predominantly local cooling effect when applied to the child's gums.

Dangerous components of teething gum gels

In 2011, the US Food and Drug Administration (FDA) called for the avoidance of any benzocaine-containing products to treat teething symptoms. This recommendation is based on the risk of developing methemoglobinemia in children under the influence of the described anesthetic. Methemoglobinemia is a rare but very serious condition that can sometimes be fatal.

EJ Ip et al. (2018) asked two hundred pharmacists working in 115 pharmacies in the San Francisco Bay Area (USA) to complete a 16-item questionnaire. The majority of respondents (63.0%) were still inclined to recommend benzocaine-containing gum gels for teething infants [18]. Pediatricians have known about the possibility of acute and chronic intoxication with salicylates contained in teething gum gels for more than forty years.

In 2014, the FDA did not recommend the use of lidocaine in teething gels for children. An overdose of lidocaine rubbed into the gums, or if a child swallows too much of it, may cause seizures, severe brain damage, or cardiovascular problems. There are also cases of accidental poisoning of children with lidocaine during its topical use, sometimes with a fatal outcome.

As it turned out, the use of teething gels is accompanied by a potential risk of developing intoxication due to the content of salicylates in them. This, in particular, is reported in the publications of GD Williams et al. (2011), as well as in the latest works of T. Nguyen et al. (2018) and K. E. Hofer et al. (2018) [19–21].

Since 2014 in the UK, the use of oral gels containing salicylates is not recommended for patients under the age of 16 years, which completely excludes such indications for their use as teething in infants. T. K. Oman et al. (2008) demonstrated a case of the development of Reye's syndrome in a 20-month-old child after using a teething gel with choline salicylate [22]. It is believed that this particular case served as the basis for the corresponding recommendations of the British Commission on Human Medicines (CHM). Although representatives of the Medicines and Healthcare Products Regulatory Agency (MHRA) are inclined to believe that the described case is more consistent not with Reye's syndrome, but with acute salicylate poisoning, the recommendation is not to use oral topical gels with salicylic salts acid is retained.

Due to the fact that all anesthetics without exception (benzocaine, lidocaine, salicylates) included in anesthetic gels can pose a danger to the health and life of children, preference should be given to those topical products that do not contain the components listed above, but natural extracts medicinal plants. A similar point of view is shared by T. V. Kazyukova et al. (2015), I. A. Khoshchevskaya (2013), M. G. Lukashevich (2016), E. I. Kleschenko et al. (2017), as well as E. A. Goreva et al. (2017) [7, 9, 10, 23, 24]. M. G. Shchegoleva writes about the preference of protective gels for gums during teething (2015) [25].

Protective gels versus anesthetic gels

One of the newest concepts in recent years is the use of gum gels during teething, which create a protective film at the site of application and do not contain sugar or parabens. Thus, quite recently S. Rosu et al. (2018) presented the results of a pilot randomized trial (open and controlled) carried out by representatives of a number of Romanian and Italian medical institutions. In the study described, a protective gel for gums was used [26].

This gel was used in 27 children (age 3–36 months) for 7 consecutive days; The FLACC system (Face, Legs, Activity, Cry and Consolability Pain Assessment Tool) was used to assess pain. The presence of teething was determined by at least three signs: local pain, swelling, erythema, hypersalivation and deep characteristics of unerupted teeth. Primary symptoms were assessed at baseline and then on days 3 and 7. In addition, the patients' parents recorded daily changes in crying, oral spasms, salivation, local tenderness, swelling and hyperemia of the gums in the charts. The comparison group consisted of 30 children of the same age, in whose treatment a standard industrial gel was used (containing lidocaine, lauromacrogol 600 and chamomile extract); The same research methods were used as in the main observation group [26].

The results of the study made it possible to demonstrate in children of the main group a significant reduction in the severity of pain and swelling of the gums (from the first to the seventh day, p = 0.034), hyperemia (from the first to the third day - p = 0.045, and from the first to the seventh day - p < 0.001 ), which was confirmed by the records of the patients' parents. When assessing the sum of indicators using the FLACC system, the differences between the observation groups were p < 0.005 (in favor of the main group) [26].

As one of the new representatives of protective gels based on natural ingredients available in Russia, one should consider Dentinale® natura, which is an over-the-counter product. Children's gel for gums during teething Dentinal Nature contains the following herbal ingredients:

• natural extract of boswellia/frankincense tree resin (Boswellia serrata);
• natural extract of chamomile (Chamomilla recutita);
• natural extract of aloe/agagae leaf juice (Aloe barbadensis);
• natural extract of saffron (Crocus sativus);
• Sweet orange peel oil (Citrus aurantium dulcis).

All of these components have a pronounced anti-inflammatory, antiseptic and regenerating effect when the described gel is applied to the gums [27]. Boswellia, in addition to the properties described above, also has analgesic properties [28].

Dentinale nature gel, when applied to the gums, forms a protective film, thereby reducing hypersensitivity, inflammation and irritation of the gums (without the use of analgesics). Additional positive characteristics of the product are the absence of sugar and parabens (esters of parabenzoic acid) in its composition.

Apparently, it should be considered that protective gels based on natural plant extracts (Dentinale Natura, etc.) are not just a full-fledged alternative to products for a similar purpose containing lidocaine, benzocaine and/or salicylates, but are significantly superior to them. Protective gels based on natural plant extracts have better tolerability and, most importantly, a better safety profile, and there are no restrictions on their use.

Literature

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V. M. Studenikin , Doctor of Medical Sciences, Professor, Academician of RAE and MAE

OOO NPSMC "Dream Clinic", Moscow

Contact Information

Teething in children: modern concepts / V. M. Studenikin For citation: Attending physician No. 1/2019; Page numbers in the issue: 7-11 Tags: baby teeth, fever, hypersalivation, itchy gums

Your baby is teething: what to expect and what to do

The child has a high fever for four days. Runny nose, cough, rash, vomiting, diarrhea... - Doctor, we didn’t want to bother you at all, but we’re already starting to worry!
Somehow this teething took a long time... - So you think these are teeth? (“Have you eaten too much henbane?!” This expression fully reflects what I would like to say, but the clinical pediatrician kept it to himself.) - Well, maybe not teeth in their pure form, but they reduce immunity, but this means that infection easily sets in... - Come on, what else is this about decreased immunity from teeth?! Do you think dentation is tantamount to HIV infection, or what? Teething does not cause any special symptoms. Someone deceived you!

Symptoms of teething

The maximum that can be expected during teething is a bad mood of the child due to unpleasant sensations, increased salivation and a desire to chew on everything. And most new teeth are discovered completely by accident, that is, their birth is not accompanied by any symptoms at all.

It's sad if you come across a pediatrician who loves this word - "teeth" - so much that he tries to explain to them everything that happens to your child. Of course, maybe the doctor is simply sparing your nerves by giving the reassuring “These are teeth,” otherwise there are questions about his professionalism.

Nevertheless, popular rumor ascribes numerous problems to dentition. They start asking the pediatrician “what to prepare for when teething” almost immediately after giving birth. At the same time, people are stocking up on various drugs.

Urticaria and food allergies in infants

26.05.2021

Urticaria in a child manifests itself as itching, redness, and blisters. It is not uncommon, but in some cases it can be dangerous. One of the symptoms of hives may be a food allergy . Its presence requires certain changes in the diet of the baby, and often his mother. What to do if you suspect a food allergy in a child and how to recognize its symptoms?

Urticaria in a child

The name "urticaria" is no coincidence, because the changes caused by it are similar to those that can be observed as a result of skin contact with nettles. Red, itchy blisters may appear in different places on the body, changing their location over the following days. Urticaria in a child is equivalent to an allergy . One of the most common is food allergies , but children, like adults, can be allergic to dusty plants, animal dander, and dust. Babies' skin is also often irritated by the use of cosmetics or washing powders.

There are several types of urticaria . Acute urticaria in a child appears on the skin as a result of a specific reason and lasts from several days to 1.5 months. Blisters on the skin can persist for more than 6 weeks. urticaria occurs . In idiopathic urticaria, the cause of the disease is unknown, which makes the treatment of skin lesions difficult.

Urticaria in a child can be dangerous if it is accompanied by swelling and rashes around the throat . It can even lead to suffocation. It is worth knowing that the cause of urticaria is not only an allergy , but also a reaction to low or high temperature, exposure to solar radiation, under pressure, as a side effect of medications.

Food allergies in infants

The hives described above are one of the symptoms of food allergies , which can be associated with digestive and breathing problems. Usually this:

• colic;
• flatulence;
• diarrhea;
• constipation;
• cough;
• juice.

Food allergies in an infant often occur when new foods are added to their diet, but can also appear in the first months of life. It is believed that the safest way to prevent allergies is to breastfeed your baby for the first six months of his life. However, it is worth noting that food allergies in a newborn can also arise as a result of foods consumed by the mother. The most common allergens include: cow's milk, eggs, grain products containing gluten, nuts, fruits such as strawberries, bananas or citrus fruits, fish and seafood.

An elimination diet is quite simple to implement when parents introduce new foods into their child's diet one at a time. Then careful observation is enough to determine the causes of food allergies . For the same reason, breastfeeding women should pay close attention to their diet and closely monitor their baby's reactions. In case of milk allergy The tendency to allergies is not always hereditary, but its presence in parents increases the likelihood of allergic reactions in the child.

Treatment of food allergies in infants

In the case of food allergies, the procedure seems clear - just avoid the factor that provokes an abnormal reaction of the immune system . However, if it is impossible to eliminate the allergenic factor, antihistamines are used. Their task is to suppress the secretion of histamine, a substance responsible for the occurrence of hypersensitivity reactions. The same treatment is used for allergic urticaria . For other types of urticaria , it is essential to make an appropriate diagnosis, which then determines treatment or specific preventive measures. Blood tests help determine the causes of hives .

Published in Allergology Premium Clinic