Babies start “gumming” and drooling on hard objects, starting at a few months of age.  This might be due to teething, or it might just be oral exploration.  You can try rubbing some teething medicine, such as Baby Anbesol or Baby Oragel, on the gums.  Ribbed teething rings, or a washcloth dipped in ice water, can give some relief.

Sometimes babies wake up fussy in the middle of the night.  If your baby has been fussy and gumming things during the day, then an occasional night waking might be due to teething.  You can try giving some acetaminophen or ibuprofen, in the usual dose for fever.  But if the waking is persistent, it’s probably not due to teething.

Some babies will pull on their ears when they’re teething;  you can try the usual teething remedies.   But if there are cold symptoms also, especially if persistent, an ear infection is also possible; give us a call if you’re concerned.

But I really doubt many of the other symptoms attributed to teething.  How could teething cause a diaper rash?  Or diarrhea?  Or a runny nose?  I can’t figure out what the mechanism would be!

Fever is supposed to be another symptom of teething.  I might believe that a low-grade fever, for an hour or two, might come from teething.  But a baby with a high fever for a day or more needs to be seen by the pediatrician.  It might be something like a virus or an ear infection, but I never find that such babies are simply teething.

Visually inspecting the gums doesn’t help much.  Generally, the white lumps under the mucous membranes lining the gums are just irregularities of the jaw bone, not new teeth.  This is especially true of lumps and irregularities on the sides of the jaw.

You can’t “feel” teeth coming in, unless they’re actually breaking through the mucous membrane.  If you see the actual surface of the tooth on the top of the jaw, then “teething” might explain a baby’s fussiness.  Sometimes there’s a little bleeding; that’s normal.  Occasionally, a dark-colored blood blister will develop over a tooth as it’s coming through; nothing needs to be done about this, since it will “pop” on its own.

But if your baby is sick, please don’t assume that teething is the cause.  It’s best to assume that a baby’s symptoms are due to a virus or other illness.  Please don’t hesitate to call us if you’re concerned.

The bottom line on teething?  I think its bark is worse than its “bite!”

–  David Epstein, MD

But most babies who cry a lot don’t have colic.  I haven’t made this diagnosis more than 2 or 3 times in my 20+ year career.  There is usually some other explanation for a baby’s fussiness.

For starters, true “colic” refers to a baby who cries all day and all night.  If your baby cries only at night, for example, and seems fine during the day, she probably doesn’t have colic, and may not have any medical problem at all.

A persistently crying baby with no other symptoms should be examined, to rule out an ear infection or other medical illness.  But most commonly, the medical exam is normal.

Here are some of the possible causes for fussiness in babies.

Overstimulation:  When my daughter was born, our friends and relatives were as excited as we were.  We had many visitors.  She slept all day, but then screamed all night.  Once we finally figured out that we needed to limit visitors during the day, she was more alert in the day, we all slept better at night.  TV is another important cause of overstimulation; I recommend that the TV be limited to an hour a day within the baby’s hearing.

The “fussy period”:  At a few weeks of age, many infants will start crying every evening.  The infant may start to get wound up just after supper, then wail on and off until he exhausts himself before midnight.  These infants sleep fine the rest of the night, and they seem fine in the daytime.  This “Fussy Period” is well known.  It is frustrating but not serious, and most babies grow out of it by about 6 weeks of age.  This is another manifestation of overstimulation.  During the day, do what you can to limit the noise, and handle the baby gently; when the baby is wailing, certainly offer feedings, holding, and other comforts; and get through it as best as you can.

Parental excitement: The noise that a screaming newborn makes is close to intolerable.  Exhausted, frightened parents can be desperate to calm the baby.  But please be assured that if the baby is gaining weight, is feeding well, and has no other sign of illness, then it is very unlikely that the screaming represents a medical emergency.  In fact, parents can inadvertently overstimulate a screaming baby.  Vigorous bouncing, loud “shh”‘ing, and patting the baby may inflame his mood, causing a vicious cycle.  Instead, the most effective action is to role-model the calm behavior that you would like the baby to perform.  You can hold the baby close, move slowly if at all, and speak quietly if at all.  The louder the infant becomes, the more quiet and soothing you can try to be.  It may take an hour, or much longer!  But, through your role modelling, your infant will learn self-soothing; he will learn to manage his own emotional state, which is a very useful skill for anyone to learn early.

Teething: probably not a cause of infant colic.  Infants may start chewing and drooling for months before the first tooth breaks through.  But infants under 2 months old are unlikely to have behavior changes due to teething.

Formula “allergy”:  Most infants can handle any commercially available formula.  But some will have a formula intolerance, manifested as persistent vomiting, diarrhea, or constipation.  Simple crying without other symptoms is rarely due to formula intolerance; but a change in formula might be worth a try.  Try switching to a soy formula, or Nutramigen (or their generic substitutes).  Don’t bother with low-iron formula; there is not enough iron in formula to cause intestinal problems, although the iron is needed to prevent anemia.  Don’t switch to another formula in less than 5-7 days; rapid formula changes will leave you unsure which one helped the most.

Gastroesophageal reflux:  In my experience, “silent reflux” is the most common medical cause of persistent crying in infants.  Stomach contents may not reflux all the way into the mouth, but the discomfort of having stomach acid refluxing into the esophagus can cause crying and arching.  Keeping the baby upright during and after feeds can help.  If not, a visit to the office might be useful; the baby should be examined, then we might try thickening the milk with cereal, or medication.  Sometimes XRays are needed.

A persistently crying newborn can be frustrating, or even frightening.  But there’s usually a treatable cause.  So don’t give up hope – and try to get some sleep!

–  David Epstein, MD

A:  Many babies spit up occasionally with feeds.  I don’t get concerned if weight gain is good, the baby eats eagerly and seems satisfied after feeding, and the baby is cheerful and sleeping well.

If the baby’s vomiting is excessive, the baby is unhappy, or if other symptoms of illness are present, the child should examined.  If the child is not suffering from another illness, I may diagnose Gastroesophageal Reflux (GE Reflux).

If your baby suffers from GE Reflux, I suggest keeping the baby upright as much as possible, so that gravity can minimize the spitting.  Sometimes, thickening the formula with rice cereal may be advised.  (Obviously this is not practical for the nursing baby.)  Occasionally, switching brands of formula might reduce symptoms; if you try changing formula, give it 5-7 days to see if the symptoms improve.  If more severe symptoms persist, medications or Xray studies might be indicated.

GE Reflux often runs in families; several siblings may all suffer with it.  Typically, infants grow out of GE Reflux by 9-12 months of age.  But in about 15% of cases, it may persist beyond 12 months; in these cases, the child may require treatment for a few years until he grows out of it.

One of my biggest concerns about long-term consequences of GE Reflux is the potential for a “feeding aversion.”  If the esophagus is inflamed from acid reflux, the baby may learn that it hurts to eat.  If he avoids eating for months or years because of the fear of pain, nutritional problems might result.  Usually, this can be avoided by early recognition and treatment of the reflux.

–  David Epstein, MD