The U.S. Food and Drug Administration (FDA) released a warning this week after receiving reports of an 18 month old child who was fatally strangled while napping with an amber teething necklace around his neck. The death of any child is devastating but sadly, as pediatricians, this death comes as no surprise. The American Academy of Pediatrics (AAP) does not recommend any necklaces or jewelry around the neck for young children, especially during sleeping. Advocates of amber teething necklaces claim the mechanism of action to be soothing chemicals that are released as a child’s skin temperature increases. Personally, I find this idea of magic yellow beads on a string, that get toasty warm and release “soothing” substances through the skin, to be the stuff of fairy tales. There was another report to the FDA of a 7 month old who choked on the wooden beads of a teething bracelet while under parental supervision. Individual pediatricians like myself have long esteemed these teething necklaces to be a health hazard and now the AAP has followed suit, cautioning against their use.
This warning comes on the heels of other FDA cautions on the use of “natural” teething remedies. Hyland’s teething tablets were recalled in 2017 by the FDA for containing belladonna, also known as deadly nightshade. If this anticholinergic compound is ingested, it can cause a fast heart rate, flushed and dry skin, blurry vision, bizarre behavior and the inability to urinate. In medical training, we had a phrase to aid in memorization, called a mnemonic, for most things. The mnemonic for anticholinergic intoxication is “hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter.” The list of these unpleasant effects again highlights that “natural” or “homeopathic” is not synonymous with safe.
Orajel is not recommended for use as well. There was an FDA warning in 2011 which was updated in 2018 on the association between benzocaine, the active ingredient in Orajel, and a fatal blood disorder called methemoglobinemia. Methemoglobinemia is a rare condition that interferes with your blood cell’s ability to carry oxygen, causing your venous blood to turn into a brown sludge. It is extremely difficult to detect as it has subtle symptoms like confusion and lethargy. You cannot pick it up on a normal pulse oximeter (the finger probe that detects your “oxygen level” when being checked in at a doctor’s office) making it even more difficult to diagnose. The short answer is to just say no to Orajel of any kind for babies.
So what is safe to use for teething? The American Academy of Pediatrics recommends soft teething toys, gentle gum massage and acetaminophen (Tylenol) in its weight based dosing (you can ask your pediatrician for this).