Child and Family Services

Dear ParentLine, It seems like only yesterday that our baby finally got over her fussy infant phase. Now she’s cranky again! Her cheeks are red and she’s sucking her fingers and drooling. Is this the teething phase? What can you tell us about how to help our baby through this milestone? Signed, Gnawing on it in Newfields, NH

Until your child is able to talk, you have to depend upon maternal instinct and your powers of observation of her behaviors to understand what she tries to tell you. With infants, as you suggested, there’s ‘fussy’ cranky behavior that can be due to hunger, a wet diaper, the need for a burp or heaven forbid, something more serious, in which case, check with your pediatrician. Part of your job as a parent is to develop the ability to ‘read’ your child’s behavior at any given time.

Based on the symptoms you describe—red cheeks, cranky plus drooling and gumming her fingers, it sure sounds like the tooth fairy’s perched over your daughter’s crib, magic wand in hand. Old wives’ tales have it that an adult would be unable to stand the pain a child feels during teething. Because your little girl can’t tell you how badly she hurts and because teething pain and its remedies are very difficult to evaluate scientifically, you’d better believe she is ‘earning’ every penny the good fairy will someday leave under her pillow when the time comes for her to part with those baby teeth.

Though the process and timetable for teething varies from infant to infant, ParentLine offers you the following information to help you help your daughter. However, first off, we strongly recommend that you line up your support team—aunts, uncles, grandmothers and fathers, friends with infants—to help you and your spouse take turns being present with your child during the day, so you can take a nap. There’s no tougher or more exhausting job than dealing with a cranky baby 24/7.

You’ll need respite so when you’re the one on watch, walking the floor with baby, you’ll have the patience and stamina to help her make it through the night and not become a cranky mess yourself. Trust us on this one. Get help so you can get the rest you need! There’s nothing worse than being a pooped parent, as you must have an inkling by now.

According to the expert at www.askdrspears.com , babies are born with a full set of twenty primary teeth. They are just buried in the gums, waiting in line for their time to sprout. Teeth push through in upper and lower pairs, usually the lower appear before their upper gum mates. Girls teethe slightly earlier than boys. The ‘rule of four’ describes how baby teeth appear. Beginning around six months, expect four new teeth every four months, until the set is complete, which is usually by two-and-a-half-years.

Dr. Spears describes the following nuisances associated with teething and ways you can soothe your baby in the process:

Drooling: During teething, expect the saliva faucet to be on. Sensitive skin and excessive saliva don’t sit well together, especially when the skin rubs against a drool-soaked bed sheet. Expect a red, raised, irritating rash around baby’s lips and chin. Place a drool-absorbing cotton diaper under baby’s chin or a towel under the sheet while baby sleeps. Gently wipe excess drool off the skin with lukewarm water and pat (don’t rub) dry. Lubricate with a mild emollient.
Drool diarrhea: Not only does the face react to excess saliva, so does the bottom. Expect loose stools and a mild diaper rash during peak teething time. This temporary nuisance will self-clear as each teething burst subsides. Apply a barrier ointment to baby’s bottom.
Fever and irritability. The inflammation caused by hard teeth pushing through soft tissue may produce a low fever (101 degrees F/38.3 degrees C) and the disposition of someone who hurts. Give baby acetaminophen as needed. Check with your pediatrician for the appropriate dosage.
Biting: The budding teether longs for something or someone to gnaw on. Teeth marks on crib rails and clicking gums on silver spoons are telltale signs of sore gums. Dr. Spears warns that babies may also nibble on your knuckles, arms, fingers, and sometimes the breast that feeds them. Offer something cool and hard. Gum-soothing favorites are a cool spoon, popsicle, a frozen bagel or cold teething biscuit, or a teething ring. Dr. Spears does not recommend commercial gum-numbing substances because it’s difficult to learn their exact contents and find research that validates their safety.
Night walking: Growing teeth don’t rest at night and neither do teething babies or their parents. A previously steady sleeper may awaken frequently during peak teething times and may have a hard time resettling into the preteething sleep schedule. Dr. Spears suggests a dose of acetaminophen before bedtime, or if baby’s in severe pain, a one-time double dose, repeating the dose four hours later if needed. Again, check with your pediatrician.
Refusing to feed: This is the most variable of all teething concerns. Some teethers never miss a meal, others accelerate their nursing for comfort, and a few may pass up even their most trusted human pacifier. Offer cool, mushy foods like applesauce and frozen fruit juice slush. Put these in a cool spoon to make a real treat.

If you are unsure whether your child is sick or is teething, Dr. Spears says, “When in doubt don’t attribute baby’s behavior to teething. Let your doctor decide.” Here are some general ways to tell the difference between teething and an illness such as an ear infection:

Teething mucus is clear saliva and doesn’t run out of the nose. Cold mucus is thick and yellow. A nasal discharge usually means an allergy or an infection, especially if accompanied by eye drainage.
Teething rarely causes a fever higher than 101 degrees F/38.3 degrees C.
Teething may be confused with an earache. Babies pull at their ears during teething, probably because of pain radiating from the teeth to the ears. Some babies just like playing with their ears. Ear-pulling in babies is an unreliable sign. With an ear infection babies usually hurt more lying down and have accompanying signs of a cold.
Babies don’t act progressively sicker with teething. As a general rule, when in doubt, have your doctor check it out.

ParentLine is a free and confidential service of Child and Family Services, a statewide, independent, nonprofit organization dedicated to advancing the well-being of children and families. Call ParentLine, 1-800-640-6486; write ParentLine, c/o Child and Family Services, P.O. Box 448, Manchester, NH; email parentline@cfsnh.org or visit our website at www.cfsnh.org.