Although parents often report fever, diarrhoea and other systemic symptoms in their infants who are teething, it is
most likely that these symptoms have another cause. Typical symptoms of teething include excessive drooling, chewing/mouthing,
appetite loss and generally unsettled behaviour. If a child who is teething becomes systemically unwell, they should
be assessed for the possibility of an underlying medical condition.
Topical teething gels and anaesthetics are not recommended as there is little evidence that they are effective in
reducing the pain and discomfort associated with teething. Teething gels containing choline salicylate are contraindicated
in children aged 16 years or under in some countries, due to the theoretical risk of Reye’s syndrome. However
in New Zealand, these products are available as Medsafe is satisfied that the safety of teething gels containing choline
salicylate in children is acceptable when they are used at recommended doses.
First-line treatment for teething pain includes self-care measures such as gently rubbing the gum or using a chilled
teething ring. Simple oral analgesics (paracetamol, ibuprofen) may be used as required in children aged three months
Extra for experts - What is Reye’s syndrome?
Reye’s syndrome is a potentially fatal condition observed in cases where febrile children have been given aspirin
(acetylsalicylic acid). The syndrome is characterised by nausea, vomiting, headache, excitability, delirium and combativeness,
progressing to coma. Cases of Reye’s syndrome peaked in the 1980s and dramatically declined after warnings against
using aspirin in children were issued. It is not fully understood whether aspirin is the sole cause of Reye’s
syndrome, or whether the presence of a metabolic disorder is also a significant factor. There have been rare cases of
Reye’s syndrome in adults, but the illness is generally less severe and causes no lasting neural or hepatic damage.
There are variable opinions of national drug regulatory authorities as to whether aspirin should be contraindicated
in children aged under 16 years or under 12 years. In New Zealand, current medicine safety datasheets for aspirin preparations
carry a warning for children aged under 12 years. However, given the availability of alternatives to treat fever in
children it would be prudent to take the cautious approach of not using aspirin in children aged under 16 years.
Although no fatalities due to Reye’s syndrome have been attributed to the use of salicylates other than aspirin
(e.g. teething gels containing choline salicylate), some countries have also cautioned against the use of these products
in children aged under 16 years.