Sleep Training While Teething

Q: What happens to sleep training while teething?

A: It’s a good question. The answer depends on a lot of factors.

First: What is Teething?

 

I define teething as the process involved in the eruption of baby teeth. Some people prefer to define teething as the one or two bad days a baby has while the teeth are actually breaking through the gums. This is a good definition, but anyone who has actually had children knows that the discomfort associated with teething starts long before the teeth actually break through.

How many of you have found that the only way to soothe your fussy baby has been to rub her gums with your finger? You can call it what you want to, but it sure seems like teething to me!

First teeth often appear between 4 and 6 months months. The earliest first tooth I’ve ever seen was in a 9-week old baby! But the first tooth can sometimes wait until a year of age to break through. After that, the process will continue until all 20 baby teeth have come through. This can take up to two years!

Teething Myths

There’s a long history of teething being blamed for all kinds of nastiness. In the early part of the 20th century, teething was still appearing on infant death certificates! Also on the historical list of teething symptoms is “blinking eyes, vomiting, neuralgia, severe head cold, weight loss, toxemia, tonsillitis, paralysis, cholera, meningitis, tetanus, and insanity.”  Fortunately, we’ve stopped believing teething was fatal, but we continue to think all kinds of symptoms are related to teething.

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teething stinks

Fever is probably the most common. The latest evidence from the medical literature suggests that teething can lead to an increase in body temperature, but not to a level that could be characterized as a fever (100.4 F rectally).

This is a good time to emphasize a point. A true fever should never be brushed off as “only teething.” If the baby has a real fever, you should pay attention to it. Contact your pediatrician if you have any questions or concerns about a fever in your infant.

These days, teething is blamed for causing diarrhea, facial rashes, diaper rashes, runny noses, and sleeplessness (more on this below!) But the best evidence we have today suggests that teething causes really only two things: 1) Drooling, and … 2) Teeth.

Can the Baby Do Sleep Training While Teething?

But let’s face it: for many babies, teething hurts! These babies are fussy more often. They want to bite on anything that gets near their mouths. They try to insert both hands in their mouths simultaneously (anyone seen a baby try this?) They swat at their ears (anything to get at those painful gums!)

One thing teething should not do is interfere with sleep. Teething pain almost never wakes a baby from sleep, but a baby who does not yet know how to sleep on her own will not be helped out much by a mouth that bothers her!

The Answer is YES

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The face of teething pain

Sleep training while teething is possible. Sleep training while teething is doable. And I recommend doing it! If you’ve started the process of allowing your baby to learn to self-soothe, there’s no reason why you should stop because of teething.

If the baby has already fallen into a daily routine (because you’ve paid attention to her cues and provided her with structure!) then small disruptions from night time teething should not cause you despair. There are many things you can do to try and make her more comfortable, and to continue with your routine.

Pain Medication

Always discuss dosing with your pediatrician before you give your baby Tylenol or Motrin. The doctor will probably tell you that you should not give Motrin to a baby less than 6 months of age. You should never give higher doses than recommended, and never more frequently than recommended. My own experience taught me that Tylenol is not anti-inflammatory enough to make any real difference to a baby who is dealing with gum inflammation from teething. So if she’s younger than 6 months old, you can try Tylenol, but rubbing her gums with your finger may be her only relief!

NO ORAGEL!

What you should not give is a topical anesthetic like Oragel or Anbesol. It’s true that the FDA has issued a warning that these medications should not be used in children younger than 2. But I have an even better reason to avoid these medications: they don’t work! The inflammation from teething occurs too deep below the surface of the gum to be touched by a topical anesthetic. It’s not worth it.

A Confession

I confess I gave homeopathic teething tablets to both my boys when they were toddlers. Most teething tablets are made of Calcium Chloride, chalk basically. I knew these tablets would not actually treat teething pain. I also knew they were completely harmless. What they did do was convince my boys that their teeth would stop bothering them. The “placebo effect” worked. They would stand inside their cribs with their hands out waiting for the tablets every night. It became part of the bedtime ritual. Bedtime rituals are good! We stuck with it because it did no harm.

Other Tricks

sleep training while teething
Yup. The old toothbrush trick

There are a ton of teething products on the market, but the truth is you don’t need to waste your money on them. If an item is clean and she can safely put it in her mouth, you can use it as a teether. We and other parents have tried the toothbrush. The frozen washcloth is always worth a try. But it my experience, nothing works better than the pad of a finger rubbing the baby’s gums. The problem of course is that you cannot keep your finger there all day.

Sleep Training While Teething Take-home Messages

  • By all means, the baby can continue sleep training while teething.
  • Consult your pediatrician about pain reliever doses and dosing intervals
  • Don’t give Oragel! It doesn’t work!
  • If you try all these things, and you need a sleep coach, I can help!

 

Troubleshooting Sleep Problems

If parents have followed my sleep method and it’s still not working, there are a number of ways of troubleshooting sleep problems that we pursue until we solve the problem.

Overstimulation

Troubleshooting 101:
I start by asking parents to describe their bedtime routine. I think of the bedtime routine as a series of highly predictable events that begins at your baby’s dinner time and ends when she falls asleep. The time frame we are talking about may be anywhere from 30 to 60 minutes in length. I listen particularly for indications that the baby may be overstimulated during this period. For example, is the lighting bright and harsh? Is the television on, even softly? Is there music playing? Are there a lot of people talking loudly? Is everybody passing the baby back and forth among themselves? If it turns out that there are too many stimuli, I discuss ways to reduce them, which sometimes is more easily said than done. In some homes there are simply too many people and too much surrounding chaos to reduce stimulation. Dr. Spock would argue that this is not necessarily a bad thing and that babies will get used to it, but Dr. Weissbluth and I would not agree with him. In general, less stimulation is better than more, and the empiric research seems to corroborate this. The trick is finding a way to reduce stimuli. The solution may be to find a quiet but well-ventilated corner of the house or apartment where light, sound, and tactile stimulation can be kept to a minimum.

Need a SLEEP COACH?

Teething

Teething pain often interrupts the process of getting a baby to learn to go to sleep. At around four months of age, give or take, a baby may start drooling much more than before and may start grinding her fist into her mouth. This is likely the start of the teething process, though actual teeth may not appear for eight months.

Colic

Colic almost always happens when babies and their parents want to be sleeping. Once all the other causes of crying have been ruled out (baby just ate so she can’t be hungry, diaper is clean, she’s not constipated, and so on), you might settle on colic as the cause. Troubleshooting colic is a subject unto itself, and beyond my scope in this post!

Constipation

This is actually a subcategory of colic. Many babies wake up crying because they have to poop and they can’t. There are many easy ways to help a baby through constipation problems. Your pediatrician can help you with these

Need for more calories?

Many of my mom-clients are so successful that their babies outgrow their supply! A healthy baby that is born to a healthy mother and grows as fast a human being can grow eventually reaches the point where 20-calorie-per-ounce breast milk or formula is no longer sufficient for her needs throughout the entire day. Sometimes the baby will signal this change by waking up in the night at times when she used to sleep. This phenomenon is real but is often short-lived because feeding is so often a self-regulated phenomenon. Breast-fed babies will stimulate their mothers to make more milk during the day, and formula-fed babies will drink larger or more frequent bottles. Sometimes it works, sometimes not.