How Safe Are Teething Gels?

Every baby is different but common symptoms associated with teething include, mild irritability, drooling, low-grade fever and loss of appetite. If your baby is inconsolable or has a high fever chances are this is not due to teething. Teething should not make your baby very sick but rather very unhappy.

It’s terribly heartbreaking to see our little ones in pain and we would do just about anything to help ease their discomfort. As a result, parents commonly resort to various teething gels. Evidence has shown that some of the ingredients in these teething gels can be dangerous and that teething gels or creams actually offer very little benefit since they get washed out of a baby’s mouth within minutes. In this post I am going to unpack these ingredients and explain why they can be so harmful.

BENZOCAINE AND LIDOCAINE

Both of these ingredients are local anaesthetics and work by numbing the gums to alleviate pain. Whilst there are differences in absorption and duration of action between the two, their side effects are very similar.

One of the most dangerous and thankfully rare side effects is the development of methaemaglobinaemia. This condition basically leads to a reduction in oxygen in the body, which can lead to death. Children younger than two have a higher risk of developing this condition and therefore benzocaine and lidocaine products are not recommended for use in children under this age, unless prescribed by a healthcare provider. 

Another problem with these products is accidental overdose. It is difficult to dose these medications therefore it’s quite possible you can give too much. Inevitably most of the gel you give ends up being swallowed and if too much is swallowed this can lead to seizures, heart problems and even death. Too much of these gels can also numb the back of the throat and inhibit the gag reflex making it easier for young children to choke.

CHOLINE SALICYLATE

Another ingredient found in teething gels is choline salicylate. Teething gels, which contain this ingredient, work by reducing the inflammation and subsequently the pain.

This is the same salicylate found in aspirin and we know that aspirin is not recommended in children under the age of 16 because of the risk of Reye’s syndrome, a rare but fatal disease. Because of the theoretical risk of developing this syndrome from teething gels which contain this ingredient, the United Kingdom has completely banned their use in children younger than 16.

As I have mentioned before, it can be tricky to dose gels correctly so there is also a risk of salicylate toxicity when using gels with this ingredient.

WHAT ABOUT “ALL-NATURAL” TEETHING GELS?

With all the hype around the dangerous ingredients mentioned above there has been an increase in so-called “all-natural” teething gels. The problem with “natural” products is that they do not undergo rigorous scientific testing using clinical trials, which aim to identify any potential side effects. Some natural remedies have been around for years and whilst these herbs may or may not be effective for some, they can be dangerous for others.

The FDA has warned against the use of any homeopathic teething gels. The concern has mainly been over compositions that contain the ingredient belladonna, which is extremely toxic in large amounts. Investigations have found that the amount in the teething products exceeds the amount stated on the label. 

Chamomile and Marshmallow root extract are commonly found in natural teething gels. They are mainly used for their anti-inflammatory properties and do have a relatively low risk of side effects. But since you never really know what you are getting with these herbal products it is recommended you simply avoid them. These products are not tested for safety or effectiveness, and you have no way of knowing if the amount of active ingredient is too small to actually have an effect, or too large to result in serious complications.

SO HOW CAN YOU EASE THE PAIN?

There are a few simpler and safer methods you can try to ease your little one’s teething pain:

1. Massage your child’s gums with a clean finger.
2. Give your child a firm rubber teething ring that has been chilled in the fridge and not in the freezer.
3. Give your child a clean and cooled damp washcloth to chew on.
4. If you need to resort to medicine use paracetamol or ibuprofen (you can read more about these medicines in a previous blogpost of mine: https://www.oneaid.co.za/medications-for-pain-fever-in-children/ ).

RESOURCES

https://www.aappublications.org/content/35/8/32.1

https://emedicine.medscape.com/article/1009987-overview

https://www.fda.gov/consumers/consumer-updates/safely-soothing-teething-pain-and-sensory-needs-babies-and-older-children

https://www.fda.gov/news-events/press-announcements/fda-warns-against-use-homeopathic-teething-tablets-and-gels

https://www.gov.uk/drug-safety-update/oral-salicylate-gels-not-for-use-in-those-younger-than-age-16-years

https://www.medscape.com/viewarticle/849029_2

https://medsafe.govt.nz/profs/PUArticles/Topical%20oral%20choline%20salicylate%20gels%20-%20safety%20in%20children%20-%20Aug%2009.htm

https://nccih.nih.gov/health/teething