Is this fever related to teething?

[pilsbury]

For the last wk or two my 1 yr old has been unsettled sleep-wise and then I noticed on Monday that his molars are coming in so out it down to that. However now for the last 24 hours he's been running a fever of 39ish - medecine is bringing it down but only for a few hours then it shoots back up. Do you think this is also the teething? Having searched online peoples opinions are v mixed as to whether teething causes high temp, I *think* my daughter had a fever too when she teethed but can't remember exactly!

[ladyruskin]

If you are at all worried you should arrange an appointment with your GP who can examine your son for any infections that may be causing the high temperature.

It is my understanding that young children are expected to have several febrile illnesses a year as their immune systems develop. My 3 yo son has had several such illnesses over the years, most of which lasted no more than 48 hours and we have managed with alternating paracetemol and ibuprofen suspensions. If they have gone on any longer or if the medication has had little effect we've taken him to the GP.

The NHS have guidelines for alternating paracetemol and ibuprofen here: http://www.nhs.uk/chq/Pages/2569.aspx?CategoryID=73

[srisky]

No can (nor should) answer this without examining your child. As LadyRuskin said, if you are concerned take your child to the GP. Hopefully it is nothing more than teething.

[Saffron]

High or prolonged fever is not likely to be caused by teething. It is more like to be the sign of a viral infection. As both viral infection and teething are common in infancy, they are likely to coincide, but there is no concrete causative value in their correlation. I.e., just because they happen at the same time mean causes the other.

Research seems to suggest that there is a mistaken belief that fever and teething are related, and that this may prevent parents or healthcare providers from giving the best treatment for illness.

http://pediatrics.aappublications.org/content/106/6/1374.short

Objective. Many symptoms are attributed to teething in infants. There is little evidence to support these beliefs, despite their implications for clinical management. We investigated relationships between tooth eruption, fever, and teething symptoms.

Methods. Prospective cohort study.

Participants. Twenty-one children 6 to 24 months old attending 3 suburban long-day care centers ??3 days/week.

Measures. 1) Daily temperature recording and examination of alveolar ridges for tooth eruption (dental therapist). 2) Daily questionnaires??symptoms over preceding 24 hours (staff and parents independently). 3) Final questionnaire??beliefs/experiences related to teething (parents).

Definitions. Eruption day??the first day a tooth could be seen or felt. Non-toothdays?Cmore than 28 days clear of any eruption day. Toothdays?Cthe 5 days preceding eruption days.

Results. Data were collected for 236 toothdays and 895 non-toothdays pertaining to 90 teeth. Child temperatures were similar on toothdays and non-toothdays (36.21 vs 36.18, paired ttest). Logistic regression adjusted for age did not show an association between toothdays and temperature (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 0.80, 2.27 for high fever; OR = 1.34, 95% CI = 0.48, 3.77 for low fever). Logistic regression models allowing for within-child cluster effects and age were fitted to daily staff and parent reports of mood, wellness/illness, drooling/dribbling, sleep, diarrhea, strong diapers, red cheeks, and rashes/flushing. Only parent-reported (but not staff-reported) loose stools were significantly associated with tooth eruption (OR = 1.86, 95% CI = 1.26, 2.73). When the toothday definition was varied to 10 days preceding or 5 days surrounding tooth eruption, this single significant association was no longer apparent (OR = 1.42, 95% CI = 0.98, 2.05 and OR = 1.47, 95% CI = 0.97, 2.21, respectively). All parents retrospectively reported that their own children had suffered a range of teething symptoms.

Conclusions. This study did not confirm the expected strong associations between tooth eruption and a range of teething symptoms in children 6 to 30 months old, although we cannot rule out the possibility that weak associations may exist (Type II error). These findings contrast with strong parent and professional beliefs to the contrary. Such beliefs may preclude optimal management of common patterns of illness and behavior in young children.

[Saffron]

See also:

http://pediatrics.aappublications.org/content/105/4/747.short

Context. Studies of infant teething have been retrospective, small, or conducted on institutionalized infants.

Objectives. To conduct a large, prospective study of healthy infants to determine which symptoms may be attributed to teething and to attempt to predict tooth emergence from an infant's symptoms.

Design. Prospective cohort.

Setting. Clinic-based pediatric group practice.

Patients. One hundred twenty-five consecutive well children of consenting Cleveland Clinic employees.

Outcome Measures. Parents daily recorded 2 tympanic temperatures, presence or absence of 18 symptoms, and all tooth eruptions in their infants, from the 4-month well-child visit until the child turned 1 year old.

Results. Daily symptom data were available for 19 422 child-days and 475 tooth eruptions. Symptoms were only significantly more frequent in the 4 days before a tooth emergence, the day of the emergence, and 3 days after it, so this 8-day window was defined as the teething period. Increased biting, drooling, gum-rubbing, sucking, irritability, wakefulness, ear-rubbing, facial rash, decreased appetite for solid foods, and mild temperature elevation were all statistically associated with teething. Congestion, sleep disturbance, stool looseness, increased stool number, decreased appetite for liquids, cough, rashes other than facial rashes, fever over 102?F [38.9 C] , and vomiting were not significantly associated with tooth emergence. Although many symptoms were associated with teething, no symptom occurred in >35% of teething infants, and no symptom occurred >20% more often in teething than in nonteething infants. No teething child had a fever of 104?F and none had a life-threatening illness.

Conclusions. Many mild symptoms previously thought to be associated with teething were found in this study to be temporally associated [i.e. occurring at the same time] with teething. However, no symptom cluster could reliably predict the imminent emergence of a tooth. Before caregivers attribute any infants' signs or symptoms of a potentially serious illness to teething, other possible causes must be ruled out.

[Saffron]

Ask to speak to a nurse or GP at your local practice. Often if they are busy, they will offer to have the nurse/GP ring you back. You can also use the NHS online symptom checker, or phone 111 for urgent medical advice. xx

[pilsbury]

Thanks everyone for their advice, much appreciated. His temp today has definetky been better today, averaging about 37.5 I'd say (though the teething pain continues apace, poor fellow, constantly clutching his face and not happy!). If his temp goes up again I'll be sure to get an appointment with the gp. Thx again, good to know for next time at the very least x