Archive for category Teething
Sometimes life can be very difficult for the parents of a crotchety baby. What’s wrong? Teething is one of first things that springs to mind. All sorts of people might give all sorts of advice, and that advice might turnout to be right, of course. Sometimes though it could be wrong. Very wrong.
The chances are, without examining the baby, if the advice given turns out to be correct, then it is just by chance, based on the probability that most babies, most of the time are not seriously ill. However, teething is a diagnosis of exclusion.
We also identified one paper highlighting the risks of attributing relevant medical symptoms to teething. This review suggests that there is no evidence that teething can be “identified” as the source of symptoms in a child. We agree with previous authors and recommend that this is a diagnosis of exclusion, to be made with caution. We acknowledge that this message may conflict with many firmly held beliefs of our patients’ parents and of other colleagues, but this review has shown that if a child is ill enough to be admitted to hospital, other organic causes need to be excluded, so that the child is managed appropriately. We also suggest that visualisation of the gums should be part of the clinical examination of the mouth and pharynx in young children to deal with the possible parental concerns, as teething has often been diagnosed on the basis of symptoms alone.
Clinical Bottom Line
No evidence is available to suggest that there are any symptoms or signs specific to teething that allow a diagnosis to be made confidently in a child without excluding other organic pathology (grade B).
It seems then, if a teething child is giving a parent or other carer (the one who knows the child best) real cause for concern, eg, inactivity, poor feeding, diarrhoea, fever, unusual cry, unusual rash, then that concern should be taken seriously. The baby should be examined by a GP or paediatrician to rule out other causes of a sick child, before the diagnosis of “teething” is made.
Remember, grannys, aunties, friends, nursery nurses, health visitors etc are not trained in the diagnosis of an ill child. Only doctors are and some of them who do not see a lot of children, are sometimes not good at it either.
Fortunately the parent who spends most time with their child usually becomes pretty good at knowing when it is appropriate to get worried, and their worries should never be dismissed as “anxiety” or “neuroticism” even if in some situations this may turn this is the case.
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