By the time your child has hit the toddler years, she has probably cut several teeth. There are certainly children with no teeth at 15 or even 18 months, but the vast majority of children get some teeth before their first birthdays. Some children don’t even wince when a tooth is coming in, but most have discomfort somewhere along the way. By the toddler years, the bigger teeth are emerging, causing more pain. A molar, for instance, is twice as big as an incisor, so it can hurt twice as much coming in.
A total of 20 teeth must emerge before all of the primary teeth are in. Contrary to popular belief, there is no “correct” order of the emergence of teeth. Some children get one tooth at a time; others get four. Sometimes the lowers come in first; other times the uppers, the molars, or even all of the teeth on one side of the mouth are the first to appear.
Despite what the term implies, teething does not necessarily mean that a tooth is ready to erupt through the gum. The process of teething refers to the entire journey of a tooth within the gum and then through its surface. As the tooth moves within the gum, it cuts through nerves and tissue, sometimes resulting in hidden swelling and inflammation. This deep movement may be more painful than a tooth visibly erupting through the topmost layer of gum.Teething pain is thought to be most acute when a child is lying down because in this position, tenderness in the gum is felt back by the ears as well. With sitting or standing, or even lying at an incline, the pain in the ears is usually less severe.
The excessive drooling associated with teething results in swallowed saliva, which can fill the stomach and reduce your child’s appetite. The saliva must pass out of the stomach and through the intestine, resulting in loose or mucus-containing stools or even diarrhea.
What can I do?
Some toddlers will soothe themselves. They will suck on their fingers or gnaw on a toy or a cold spoon. Older kids may rub their fingers or tongues along their gums to massage the area.
If your child is having teething pain and cannot soothe herself, you can rub her gum or offer something cool to help reduce the inflammation. But be careful: your toddler’s mouth already has “any teeth, and with teething pain, she may inadvertently bite down to find relief. A variety of medicines is available for extreme teething pain.
When does my doctor need to be involved?
Doctors rarely need to be involved in a child’s teething. However, may be difficult for you to determine whether your child’s discomfort is from teething or from something else going on. Problems that may imitate teething include infections at the back of the throat and ear infections.
If your toddler tells you that she is having pain but refuses to let you look in her mouth, you will likely wind up seeing the do¬tor. Although it may be frustrating to be told “It’s just teething,” better safe than sorry.
A few clear signs suggest that your child’s pain may be due to an infection rather than teething. These include a fever higher than 101°F, complaints of ear pain or repeated ear tugging, decreased appetite, or complaints of tremendous discomfort. When these symptoms are present, you should take your child to le doctor.
Drooling is often a sign of teething, but if the drooling is exces¬sive, or if it seems that your child is having difficulty swallowing her saliva, you should see your doctor.
What tests need to be done, and what do the results mean?
A good physical exam is the only “test” needed in the case of teething. If the exam turns up nothing at the back of the throat, no ear infection, and no other source of pain or infection, teething is the default diagnosis. Your doctor might mention that the gums look swollen, but remember that gums don’t have to swell visibly for there to be teething pain.