Dr Phil Kieran: What kind of pain relief should I give my teething baby?

An initial response to teething discomfort is something cold for the child to chew

half-year-old baby lies on his stomach on the bed smiling

My eight-month-old son cut his first tooth and was distressed. What painkiller would you recommend for teething?

Before I had children, I heard a dentist on the radio say that teething was as painless as getting a haircut. Having had children and with over a decade in general practice, I believe that teething can cause difficulties.

Teething symptoms include crankiness, chewing, and drooling, but I would be less keen to say teething causes fever or diarrhoea.

When a parent brings their child in to see me with teething-related symptoms, my task is to rule out any other cause.

If the pain seems severe, I would be concerned that I could miss another cause if I just put it down to teething.

Viral illness is the most common cause of the symptoms that worry parents of teething children, and usually these are short-lived, self-limiting conditions that last three to five days. If the child has a runny nose, cough, and is off form, I conclude that a cold rather than teething is the cause.

I believe this is why many specialists tell us not to put everything down to teething. If the baby seems to have a sore mouth, you should look inside to make sure there are no sores or ulcers.

The cold-sore virus and hand-foot-and-mouth disease can cause pain in a child’s mouth and are unrelated to teething.

This all-encompassing approach doesn’t help you if your child is sore and the reason is teething. An initial response to teething discomfort is to give the child something cold to chew on.

A teething ring that has been in the fridge (not freezer) is an ideal first-line treatment. Cold fruit is also a good idea, if your child is on solids.

I don’t recommend teething toys with multiple parts (necklaces or bracelets), as the parts can detach and become a choking hazard. Over-the-counter gels or powders work through one of three mechanisms. The simplest are sugar compounds that have a pain-relieving effect, but which can damage new teeth. Next are ones that contain local anaesthetic, which can cause potentially significant side effects and don’t seem to work particularly well in research trials. Then there are natural or herbal supplements, most of which have not been shown to help and which occasionally have harmful concentrations of naturally occurring toxins (most notably, deadly nightshade in one FDA study in 2017).

If the basic treatment of firm chewies and cold objects isn’t helping, a dose of paracetamol is worth trying. However, I would caution that if you don’t notice a significant improvement about 20 to 40 minutes after the dose, stop giving medicine for the pain.

• If you have a question for Dr Phil, please send it to [e-mail]