University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• A 10-month old boy presents to the ER with a fever of 103°F status post a febrile seizure. His parents initially attributed his fever to teething. In infants with fever, may the fever be directly attributable to teething?

Clinical Bottom Lines

1. Fever in infants is commonly ascribed to teething, both by health care professionals and, more commonly, parents.^1,2
2. Contemporaneous prospective cohort studies suggest that, at most, teething can give rise to mild fever in the period immediately surrounding tooth emergence.^3,4
3. Parents of infants should be cautioned not to attribute fever to teething without considering other etiologies.
4. Practitioners should assume that fever in their patients is not caused by teething, especially fevers that are greater than or equal to 102°F.

Summary of Key Evidence

1. 111 infants presenting for their 4-month WCEs were enrolled in an 8-month long prospective cohort study in which parents recorded daily body temperature, tooth eruption, evidence of 18 symptoms commonly believed attributable to teething, and child illness.³
2. Temperatures greater than one standard deviation above the child's mean were significantly associated with tooth emergence only on the day of emergence or one day earlier.
3. Temperatures > 101°F also showed a significant association with tooth emergence.
4. There was no significant association between tooth emergence and temperatures greater than 100°F, 102°F, 103°F, and 104°F.

Additional Comments

• To mask the purpose of the study, parents were told that it was intended to examine normal infant behavior. The authors, however, observed that most parents seemed to discern that the questionnaire was designed to study teething, thus possibly introducing surveillance bias.³
• None of the fevers higher than 104°F and only one fever over 103°F that occurred during the 369 recorded tooth eruptions were unexplained by another illness known to be associated with fever.³
• A contemporaneous prospective cohort study of the relationship between teething and possibly associated symptoms in 21 children found no significant relationship between teething and fever.⁴
  

Citation

1. Wake M, Hesketh K. Teething Symptoms: cross sectional survey of five groups of child health professionals. BMJ 2002;325:814.
2. Wake M, Hesketh K, Allen M. Parent beliefs about infant teething: a survey of Australian parents. J Paediatr Child Health 1999;35:446-9.
3. Macknin ML, Piedmonte M, Jacobs J, Skibinski C. Symptoms associated with infant teething: A prospective study. Pediatrics 2000;105:747-752. See also http://www.med.umich.edu/pediatrics/ebm/teething.htm
4. Wake M, Hesketh K, Lucas J. Teething and tooth eruption in infants: A cohort study. Pediatrics 2000;106:1374-1379.

CAT Author: James Azim, MD

CAT Appraisers: John Frohna , MD

Date appraised: June 8, 2005