Teething

Infants begin teething between four and six months of age. The first teeth to come in are often the bottom two middle teeth, followed by the two upper central teeth.

Symptoms associated with teething are increased drooling, swollen gums, increased fussiness and general discomfort. A slight temperature is frequently associated with teething, but a temperature over 100.4 is atypical and your pediatrician should be called.

Treatment for teething consists of applying a cool wash cloth to your child’s gums, applying teething gels like Nums‐it or Orajel, allowing your child to gnaw on a cooled soft toy like a “teething ring” and finally giving Tylenol or Motrin (if older than six months) if your child has significant discomfort. 

Ear Pain

Ear pain is one of the most common complaints in children. As there are many possible causes of ear pain, it is important to have your child evaluated by a physician. It is difficult to assess a child’s ear pain over the phone and cannot be diagnosed appropriately. There are three main causes of ear pain, and we will discuss each one briefly.

1. Inner Ear Infection: Inner ear infections may be caused by either a viral or bacterial infection and therefore not all infections require antibiotics. A recent cold or nasal congestion or fluid in the inner ear places your child at greater risk of an ear infection.

   a. Symptoms include: ear pain, fever, irritability and nasal congestion.

b . Treatment for inner ear infections is typically antibiotics, but in some circumstances, it is okay to watch for 48 hours to see if this will resolve without intervention. Tylenol and Motrin and numbing ear drops will help with pain symptoms.

1. Outer Ear Infection (Swimmer’s Ear) is an infection in the ear canal. Children who swim or have frequent contact with water are at greater risk. Water in the canal can cause irritation and can allow for bacterial infection.

   1. Symptoms: outer ear pain, especially when pulling on ear; discharge from the ear canal. Some children will also develop a fever.

   2. Treatment: antibiotic ear drops

   3. Prevention: if your child develops recurrent outer ear infections, thorough drying of the ears after swimming and bathing may decrease incidence. Over the counter ear drops such as Swimmer’s Ear work well.

2. Teething: Even though it is the gums that are painful and swelling, a child may feel the pain in the ear and this is what is called “referred pain.” The molars are the ones that particularly cause referred pain.

   1. Symptoms: drooling, low‐grade fever, pulling or gnawing on toys

   2. Treatment: see teething section for more details: massaging gums with finger or a cool wash cloth, Tylenol or Motrin for severe symptoms.