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Teething

by Doctor Laurence H. Miller on 06/27/11

Teething is one of the most mentioned and most misunderstood concerns of parents of young babies. Many symptoms are blamed on teething: colds, fever, cough, vomiting, hunger, diaper rash, irritability, drooling.

It is possible for an erupting tooth to cause drooling in a 6 or 7 month old infant. It's almost always the upper or lower central incisors. But drooling can even occur before any teeth, when a smart baby starts to imagine his/her next meal, and that starts the saliva flowing to get ready for feeding time.

Low grade fever is still a questionable result of teething. But certainly not HIGH FEVER. Tragedy can occur when a misled parent mistakes the high fever of serious bacterial infection, such as meningitis, for "teething fever".

Many parents believe a diaper rash is more likely to appear during teething. This actually could make sense if you consider that some people have a change in their bowel movements, with increased frequency and looseness, when they are in pain. So teething pain could cause the right circumstances for a diaper rash.

On occasion, we have seen a baby pulling at her ears and instead of an ear infection being the cause, swollen, throbbing gums are the cause of the pain. The baby has a tooth pushing out, and as it erupts, it irritates the nerve that ends inside the ear. This results in the "referred pain" which misleads the family into thinking there is an ear problem. Simply looking into the mouth and finding the brand new teeth correct the misperception.

Most parents agree that the most likely time of day for "teething" irritability is evening bedtime/cribtime. Does this make sense? It certainly does! When the baby is playing with family and receiving distracting stimulation, he may not be aware of throbbing, swollen gums. But alone, in a dark, silent crib, any sensation of pressure coming from a tooth slowly pushing its way out through the gum, will be magnified greatly! And the baby may feel panic that this pain will last forever.

It has recently been reported in the scientific literature that local pain relievers such as gels should NOT be rubbed on the infant's gum to numb it. This can cause DANGEROUS reactions. I advise wetting a baby wash cloth and putting it in a plastic bag in the freezer. Then offer the frozen cloth (without the bag!) for the baby to suck on. The cold is slightly numbing as a pain reliever and refreshing, soothing for the baby to bite into as it is firm but yielding. If crankiness persists, a dropperful of infant ibuprofen (advil or motrin) is more likely to give relief than tylenol. I am not a big fan of routine use of these medicines, but a baby suffering at night should be given comfort. As a rule I offer these drops ONLY at night for baby and parent relief. Many old time pediatricians (and grandmothers!) have recommended a drop of whiskey applied to swollen baby gums. I haven't seen this in the journals and clearly caution would be key as alcohol poisoning is unacceptable to consider. However, if the cold rag fails to give relief, and a dropperful of ibuprofen is no help, a single drop of liquor rubbed once, and once only at bedtime, directly on the swollen gum, can be of great help, to everyone.

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Croup

by Doctor Laurence H. Miller on 06/17/11

A pediatrician races across night-time Central Park in New York, a desperately ill

three year old struggling to breathe in the back seat of his car. The little boy's

voice is croaking, raspy with stridor as they begin their journey on the West Side.

Now as they approach the East 67th Street exit, the doctor hears the excited tyke

happily pipe up: "Oh! Look! The Zoo!" The doctor who took this hair-raising ride

was my mentor and eloquently gives color to the dramatic relief the damp evening

air often gives to a child whose throat has nearly closed.

Croup is one of the emergencies that puts fear in the hearts of parents and sometimes

doctors as well. The sound of its cough is best compared to the bark of a dog or a seal.

Sometimes parents mistakenly describe the difficulty the child has breathing as

"wheezing", but actually it's called stridor. Wheezing is the sound made when one

has trouble exhaling. Imagine stridor as trying to take a breath in through an

old-fashioned paper straw that's nearly collapsed. Think of "wheezing" as the sound

a balloon makes when you let the air out of it while pinching off the neck most of the

way. I usually explain croup as a severe laryngitis in little children. While irritation

might just cause a hoarse voice in a bigger person, the comparable swelling in a tiny

toddler's voicebox (larynx) and/or upper windpipe (trachea) can cause real breathing

difficulty. According to the laws of physics, resistance to flow of a liquid or a gas

through a tube is increased exponentially as the radius becomes smaller.

That explains why a little swelling in a little windpipe is such a big deal and just an

annoying hoarseness in a grown-up.

The most common cause of croup is a viral infection of the upper respiratory tract

(URI). It can also happen from allergy. Fever may or may not be present. The nose is

quite often stuffed or running. But the most predictable features are the time of day:

evening; and the time of year: the autumn and winter months. This is probably

because the insult of the viral inflammation is added to the dryness of the air that time

of year and household heating which is also aggravating.

I recommend a cool-mist humidifier in the child's room at the first sign of hoarseness

or noisy breathing. Warm or hot steam vaporizers are a terrible idea. The potential

danger of a scald burn makes them unacceptable. If the child seems to be getting worse

over the evening, it's often quite helpful to have him sit on a parent's lap in a bathroom

that's been steamed up by a hot shower running. Ten or fifteen minutes are the maximum

time limits for the treatment; I've heard horror stories of misguided folks causing severe

heat prostration in their baby by prolonged use of this steam treatment.

If the situation is not improving, it's time to get moving. Put the child in the car seat

and taking a leisurely drive around the block with the car windows open two or three

inches. If the parent doesn't see rapid improvement at this point, they should be

headed for the nearest emergency room.

I remember bundling up my eighteen-month-old daughter on a November night

about ten PM. She was having just mild stridor, but I didn't want to fool around so I put

her in her stroller and slowly ambled up the middle of our suburban street. She stared

up fascinated by the night sky and the trees blowing. She wondered aloud, "Daddy,

what are we doing?" "We're just taking a little walk honey. Isn't it beautiful out now?"

But in less than ten minutes outside, her breathing was basically normal and totally comfortable.

Having croup as a child doubles a person's odds of having allergies later.

The best news is that pediatricians have proven conclusively that if a child suffering

from moderate or severe croup is treated with a drug from the "steroid" family, the distress

is reduced in a dramatically shorter time than with mist alone. This could spare a child from

being hospitalized. The actual name of the medicine might be Decadron (dexamethasone),

Prelone (prednisone), or hydrocortisone. The medicine can be given orally or as an injection

for a day or two and then stopped without a recurrence of the illness.

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