Q&A: pain relievers for teething

Amy writes:

"You mention in your supplements for pregnancy post that you are not much of a pill-popper, and in fact have been working on the same bottle of ibuprofen for 5 years (I paraphrase). So I respect your reluctance to overmedicate and with that in mind I pose this question:

What are your feelings on Tylenol and Motrin (or acetaminophen and ibuprofen)? Here's the true-life scenario playing out at our house this weekend: Baby, almost 7 months old, has her first  I-don't-know-what. Cold? Some congestion, some wet-sounding coughing, some fussiness. Last night her normally stellar sleep habits were all out of whack and we had to drive her around in the toasty car to get her to sleep. (Usually she's down at 7 easily and sleeps until about 5 or 6. We are lucky in that regard.) She doesn't have a fever, but she is cutting teeth. Knowing how much longer than usual it took to get her to sleep last night, I went ahead and gave her a dose of Tylenol before putting her down tonight. She cried in a lackluster way for about 10-15 minutes, and then went to sleep.

The other day I mentioned having given her Tylenol for teething pain to an acquaintance (yes, we use Hyland's gel too). He smiled knowingly and said "Ah, liquid sleep!" I try not to feel defensive about parenting stuff, but I confess I felt a twinge of guilt when he said that, and he wasn't even saying it in a disapproving way. It's just that I suddenly wondered if I am too quick on the trigger, or dropper rather. Your thoughts?"

I have this thing about informed constent. I just don't think I have the right to do something painful or permanent to a person without their informed consent unless there's a clear, definite reason for doing it. This is why I'm anti-circumcision for my own boys--there was no way they could consent, and they certainly couldn't be informed. (They can do what they want to when they're old enough to understand and consent, and it won't be my business.)

Pain relief falls under that same idea for me. I don't take anything for my own pain very often, but I don't think it's fair to deny pain relief to someone who can't ask for it in any way except by crying. If there was overwhelming evidence that the dangers of Tylenol and Motrin were huge I'd reconsider, but they're both generally safe in the small, infrequent doses that a baby gets during teething. So I definitely use them when my kids are having a particularly rough time.

I do try other things, though, first. I use a lot of homeopathic remedies (my kids' pediatrician is an MD and also a homeopath) and usually try either Humphreys #3 pellets (in a sugar base; you can get them OTC for around $5 from a pharmacist, who can special-order them for you and they should come in within a day or two) or Hylands Teething Tablets (in a milk base; you can get them for around $5 at a natural foods store). I'm not a fan of the Hylands Gel, which has been worthless for my kids. The homeopathic remedies are great at easing the crankiness and restlessness of teething, but they don't do much for the really painful nights.

Our pediatrician told us to try to avoid Baby Anbesol and Oragel, because even the baby formulations can be too strong and can kind of burn the gums (like a frostbite kind of burn).

I'm really not crazy about baby Tylenol because I don't want to give an infant the artificial flavors and colors. Plus it's hard to measure out in the middle of the night, and they always end up spitting out half the dose. So I was thrilled to discover acetaminophen suppositories. No artificial colors or flavors, no measuring, and they get the full dose. Just remember to keep them in the refrigerator so they don't melt all over.

I wish I could find ibuprofen suppositories, because the ibuprofen works so much better, and I hate the fake bubble gum (for babies?!) flavor.

So that's what I do for teething.

It sounds to me like all her problems are symptoms of the teething. Some common symptoms of teething are:

* biting hands or anything that comes near their mouths
* crying out in yelps of pain
* drooling
* runny nose or congestion from drooling
* "smokers' cough" from the drool going down the back of the throat
* spitting or throwing up from drool going into the stomach
* "drool stool," which is shards of drool in the poop (I know, and it's truly stunning when you see it)
* rash around the mouth
* rash around the anus
* acidic poop (sometimes you can even smell the difference) and a burned monkey-butt look after pooping
* tugging or pulling at the ears
* not wanting to nurse
* biting while nursing
* flash fevers (fevers that come out of nowhere and are gone in 30 minutes to an hour)

Are there any I'm forgetting? Some kids never have any of these symptoms, some have a few, and some lucky children (like mine) have all of them. The congestion and cough sound like they could be from the drool. I hope her teeth come out quickly and she (and you!) gets some peace and sleep, and that the poor little thing stops crying "in a lackluster way" (which gave me a mental image of Simon Cowell telling her she has a beautiful voice but he just didn't believe the crying, and she needs to work on "connecting" to the crying more for next time).

Comments

[Amy]

Moxie,
When you said you can sometimes "smell the difference" in the baby's poop, you weren't kidding! My toddler has had many of the symptoms you describe, and when she is cutting molars, her stools smell like adult vomit. I am not kidding. It's enough to make me want to fumigate the room after changing one.

Also, Tylenol is hardly "liquid sleep." (Benedryl, on the other hand...)

[Beth]

Wow, that list of teething symptoms is eye-opening. I think my son is teething! It never even crossed my mind, because he's only about 11 weeks, and I didn't cut a tooth until I was nine months old. He has every symptom except any obvious signs of actual pain - yelling out, fussiness, etc. He does get pissed when he can't quite get the fist to the mouth, though. Maybe we're in the early stages.

[Jenny]

Ah, the teeth. Teething has by far been the worst thing we've encountered in our 2.5 years as parents, mostly because our daughter's teeth take forEVER to come in... a few times they've actually poked through slightly, then receded! only to cause more agony on re-entry.

With each cutting, we have weeks or months of intense crankiness and clingyness, poor sleep, yelps of pain, bloody gums... and though Hylands' tablets take the edge off, and Tylenol helps a bit, the only thing that lets our kid sleep for more than 3 hours straight at night is ibuprofen. Perhaps because it has anti-inflammatory qualities that acetaminophen does not. (?)

I give her Hyland's during the day to help calm her and ease the general crankiness, and then use motrin at night. I really don't like giving her motrin once a day for weeks at a time... I too take years to go through a bottle of Advil. But her pain and our sleeplessness were both acute. And I have to say, it substantially improved our quality of life during the Reign of Teething Terror.

Luckily, not all kids experience this! We're thrilled to be in the final leg of teething, ourselves: only some two-year molars left. Her pain tolerance seems to have increased with age, as well - the later teeth were not so excruciating.

The big lesson, though, was just how delightful one's child can be when she's not in pain! I recommend that folks try out different ways of alleviating pain, starting with the homeopathic remedies... they might be surprised to find that their child is considerably more charming than they had originally presumed.

PS - an "interesting" (read: possibly crazy) guy in line at the post office one day lectured me about giving my child calcium and other mineral supplements (manganese? can't recall), and swore that they would completely eliminate all teething pain. I couldn't find anything to corroborate this, but would be interested if anyone else has heard of such things.

Sorry for the long comment. Can you tell my life has revolved around this topic for awhile?! Yikes.

[Kate]

Funny, Advil did not work for us. Tylenol took the edge off when we knew she was in the midst of a bad stretch (but we hated to medicated in the middle of the night when she woke crying--it could have been teeth, stomach, anything); Orajel (yes, bad parents) was good for middle of the night screams.

But the only thing that really truly worked was nursing. There was a 2 week stretch of biting (like you mentioned), but after that it was the only thing that could soothe her enough to put her back to sleep and keep her that way....for a few hours.

One more "symptom" I'd mention--at least it seemed to be for us--was unexplained restlessness during sleep. Because of all the night nursing at this time, she was with us in bed for long stretches and we noticed that she was doing a lot of moving. She'd wind up perpendicular to us. It wasn't peaceful!