The U.S. Food and Drug Administration advised all parents last week to throw away homeopathic teething gels and tablets after 10 deaths and 400 “adverse effects.” I have previous discussed teething medicines and strongly advised against using them but this is a different kind of product and it is not clear why it would be harmful. The important point is just stop using teething medicines of any sort.
Babies are often not easy and when a child after two or three months and before age 2 years has a combination of irritability, hard to soothe, and is drooling—a lot parents and medical providers call it teething. There have been many products used for this problem over time:
People rubbed alcohol like whiskey on the gums when I was little. Babies sometimes stopped crying because they fell asleep, but sometimes they just got irritable and occasionally died from alcohol overdose.
Paregoric (which is opium dissolved in alcohol) was widely used up until the late 1970s and was available without a prescription. This was taken off the market because along with the soothing, repeated use could lead to addiction and then withdrawal. It also almost always constipated the infant.
Benzocaine (and other topical anesthestics) containing preparations such as Oragel may not work and can lead to the baby turning blue because of a rare side-effect called methemoglobinemia. The child may require hospitalization to resolve this problem where the body makes a form of hemoglobin that will not carry oxygen.
Gripe water which has no consistent list of ingredients and is used for almost anything that bothers a baby is just plain dangerous. We really don’t know what is in it. It has been found in overseas preparations to have toxins such as lead and alcohol. I have had several children who were given the brand sold in Chinese import shops and ended up with severe belly aches.
Now homeopathic teething gels, especially those made by Hyland, with tiny amounts of Belladonna (also known as the poison “deadly nightshade”) have been associated with deaths in babies. Belladonna in small amounts affects the parasympathetic nervous system and was called “beautiful lady” because it dilated the pupils and gave a “big eyed” look that was thought very attractive. But in larger amounts, belladonna dilated the blood vessels and could lead to heart failure. These teething gels had so little belladonna that it is not clear why any babies died or got ill, but the FDA has withdrawn them. Do not use them!
So what do you do for teething?
- Pick up the baby, sway, sing and swaddle.
- Putting a cold rag or a little ice on the gums is effective, but do not enough ice to actually make the baby so cold he shivers. One of the sucking devices that can be put in the freezer also works.
- Acetaminophen (Tylenol) according to weight (no more than 3 times in 24 hours):
1.25 ml of 160 mg/5 ml for 5 ½ to under 11 lb
2.50 ml of 160 mg/5 ml for 11 lb to 16 lb
3.75 ml of 160 mg/5 ml for over 16 lb to under 22 lb
5.00 ml of 160 mg/5 ml for over 22 lb
Ibuprofen (Motrin and Advil) is not recommended in this age group
Do not overdo. Teething is not the end of the world. It comes and goes and do just enough to make the baby comfortable