Teething

Last updated
A 9-month-old infant with a right lower central incisor about to emerge Teething.jpg
A 9-month-old infant with a right lower central incisor about to emerge
A 9-month-old infant with a visible right lower central incisor Teething 2.jpg
A 9-month-old infant with a visible right lower central incisor

Teething is the process by which an infant's first teeth (the deciduous teeth, often called "baby teeth" or "milk teeth") appear by emerging through the gums, typically arriving in pairs. The mandibular central incisors are the first primary teeth to erupt, usually between 6 and 10 months of age and usually causes discomfort and pain to the infant. [1] It can take several years for all 20 teeth to complete the tooth eruption. Though the process of teething is sometimes referred to as "cutting teeth", when teeth emerge through the gums they do not cut through the flesh. Instead, hormones are released within the body that cause some cells in the gums to die and separate, allowing the teeth to come through. [2]

Contents

Teething may cause a slightly elevated temperature, but not rising into the fever range of greater than 38.0 °C (100 °F). [3] Higher temperatures during teething are due to some form of infection, such as a herpes virus, initial infection of which is extremely widespread among children of teething age. [4]

Signs and symptoms

The level of pain that a baby can handle will be different for each child. Some may appear to suffer more than others while they are teething. The soreness and swelling of the gums before a tooth comes through is the cause of the pain and fussiness a baby experiences during this change. These symptoms usually begin about three to five days before the tooth shows, and they disappear as soon as the tooth breaks the skin. [5] Some babies are not even bothered by teething.

Common symptoms include drooling or dribbling, increased chewing, mood changes, irritability or crankiness, and swollen gums. Crying, sleeplessness, restless sleep at night, and mild fever are also associated with teething. [6] Teething can begin as early as 3 months and continue until a child's third birthday. [7] In rare cases, an area can be filled with fluid appearing over where a tooth is erupting and causing the gums to be even more sensitive. Pain is more often associated with the eruption of molars since they are larger, and do not penetrate through the gums as easily as the other teeth.

Some noticeable symptoms that a baby has entered the teething stage include chewing on their fingers or toys to help relieve pressure on their gums. Babies might also refuse to eat or drink due to the pain. Symptoms will generally fade on their own, but a doctor should be notified if they worsen or are persistent. Teething may cause signs and symptoms in the mouth and gums, but does not cause problems elsewhere in the body. [8]

Pulling on the ears is another sign of pain: the pain in the mouth throbs throughout the baby's head, so they pull their ears believing that it will provide relief. Mild rash can develop around the mouth due to the skin irritation caused by excessive drooling or dribbling. [9]

Sequence of appearance

Stages of tooth emergence, at 0 months, 6 months, 9 months, 12 months, 2 years, 3 years, 4 years and 5 years. TemporalTeethDeveploment.gif
Stages of tooth emergence, at 0 months, 6 months, 9 months, 12 months, 2 years, 3 years, 4 years and 5 years.

The infant teeth tend to emerge in pairs – first one lower incisor emerges, then the other lower incisor, after which the next set begin to emerge. The general pattern of emergence is:

  1. Lower central incisors (2) at approximately 6 months
  2. Upper central incisors (2) at approximately 8 months
  3. Upper lateral incisors (2) at approximately 10 months
  4. Lower lateral incisors (2) at approximately 10 months
  5. First molars (4) at approximately 14 months
  6. Canines (4) at approximately 18 months
  7. Second molars (4) at approximately 2–3 years

Milk teeth tend to emerge sooner in females than in males. The exact pattern and initial starting times of teething appear to be hereditary. [10] When and how teeth appear in an infant has no bearing on the health of the child.

Misdiagnosis as teething

Teething has not been shown to cause fever or diarrhea; [11] however, the belief that teething causes fever is extremely common among parents. [12] Whilst there is some evidence that teething can cause an elevated temperature, it does not cause fever (medically defined as rectal temperature greater than 100.4 °F (38.0 °C)). One small 1992 study found a significant rise in temperature on the day of eruption of the first tooth. [4] Another study in 2000 found "mild temperature elevation" but not fever over 102 °F (39 °C). [13]

There is a risk that fever around the age of teething is dismissed as due to teething when it is actually due to illness, particularly infection by herpes viruses. "Coincidentally, primary tooth eruption begins at about the time that infants are losing maternal antibody protection against the herpes virus. Also, reports on teething difficulties have recorded symptoms which are remarkably consistent with primary oral herpetic infection, such as fever, irritability, sleeplessness, and difficulty with eating." [14] "Younger infants with higher residual levels of antibodies would experience milder infections, and these would be more likely to go unrecognized or be dismissed as teething difficulty." [14] Herpes virus infection may take the form of primary herpetic gingivostomatitis (HSV-1) [12] [15] or of infection by human herpesvirus 6 (HHV-6), which infects 90% of children by age 2. [16] "The symptoms of elevated temperature and facial rash could be explainable by infection with the HHV-6 agent, which is ubiquitous among infants of teething age." [17] Other viruses[ example needed ] may also cause fevers which might be misattributed to teething, [18] but the oral involvement that may occur with herpes viruses makes misdiagnosis a particular risk for such infections. [19]

Treatment

Baby teething on a magazine, 1940 1940 govt photo minnesota farming scene chippewa baby teething on magazine indians at work.jpg
Baby teething on a magazine, 1940

Infants may chew on objects to aid in the teething process. Teething necklaces or bracelets are not recommended as they can cause choking, strangulation, or irritation of the mouth. [20] Teething rings and other toys, called teethers, are often designed with textures. Some infants gain relief from chewing on cold objects. Some people freeze small chunks of fresh fruits or vegetables and put them in teething nets. [ citation needed ]

Medication

In cases where the infant is in obvious pain, some doctors recommend the use of non-steroidal anti-inflammatory drugs (NSAIDs) or child-safe pain-relief treatments containing benzocaine, lidocaine, or choline salicylate. Benzocaine must be used cautiously because it can cause methemoglobinemia; [21] choline salicylate is related to aspirin and "may cause Reye's syndrome in susceptible children, especially those with or recovering from viral infections, or when used in combination with other NSAIDs". [22] 5% lidocaine gel produces anaesthesia (numbing) within 2–5 minutes, lasting for 10–20 minutes. [22] However, one author concludes that, "Overall, the risks and adverse effects from inappropriate or prolonged use of pharmacological agents outweigh their potential benefits." [23] She points out that "the psychological trauma involved in administering medications or applying topical preparations to infants must be considered", [23] and argues that "the placebo effect must not be overlooked. For example, applying a gel of 20% benzocaine in polyethylene glycol may give only a modest benefit over applying the placebo, which gives an efficacy of 60% compared with 90% for the active preparation." [23]

Medicines are often applied to the babies' gums to relieve swelling and pain. These gels are similar to the toothache gel that is used by adults for sore gums and toothaches, but is administered in much smaller doses. Teething gels work as a numbing agent to dull the nerves in the gums so that the pain is less noticeable. It is important to follow the directions on the package to ensure that the correct amount of medication is administered and that proper techniques are used to reduce the risk for infection. It is important not to let the medicine numb the throat as it may interfere with the normal gag reflex and may make it possible for food to enter the lungs. [24] Similar medicines are also available in powder form, as "teething powder".

Acetaminophen (paracetamol) and ibuprofen are also recommended to treat the pain and swelling that babies experience. It should only be used a few times a day so that it does not mask symptoms that are being experienced due to other medical conditions and not because of teething. Products that contain aspirin should never be given to a child unless directed by a pediatrician, due to the risk of Reye's syndrome.

Some traditional medicines used to treat teething pain have been found to be harmful due to high lead content, with effects including toxic encephalopathy. Surma or kohl has traditionally been used in the Middle East and Indian subcontinent as a teething powder, as have the Middle Eastern saoott/cebagin. Santrinj – a 98% lead oxide product otherwise used as a paint primer – is also used in the Middle East as a home remedy for teething. [25]

History

Early twentieth century teething ring and pacifier. Teething Ring.jpg
Early twentieth century teething ring and pacifier.

Teething used to be considered (wrongly) a cause of death, as many children died in the first years of life, at the same time as teething occurs. "The tendency in the past to attribute serious disease to teething was so prevalent that in 1842 teething was the registered cause of death in 4.8% of all infants who died in London under the age of 1 year and 7.3% of those between the ages of 1 to 3 years according to the Registrar General's report." [4]

Ironically, while teething is a natural process which creates little more than discomfort, some methods for relieving teething pain have caused serious harm and even death. Old remedies for teething include "blistering, bleeding, placing leeches on the gums, and applying cautery to the back of the head". [26] In the sixteenth century the French surgeon Ambroise Paré introduced the lancing of gums using a lancet, in the belief that teeth were failing to emerge from the gums due to lack of a pathway, and that this failure was a cause of death. This belief and practice persisted for centuries, with some exceptions, until towards the end of the nineteenth century lancing became increasingly controversial and was then abandoned, although as late as 1938 an Anglo-American dental textbook advised in favour of lancing, and described the procedure. [26] In the first half of the twentieth century, teething powders in the English-speaking world often contained calomel, a form of mercury. It was removed from most powders in 1954 when it was shown to cause "pink disease" (acrodynia), a form of mercury poisoning. [27]

Teething toys have a long history. In England in the 17th–19th centuries, a coral meant a teething toy made of coral, ivory, or bone, often mounted in silver as the handle of a rattle. [28] A museum curator has suggested that these substances were used as sympathetic magic, [29] and that the animal bone could symbolize animal strength to help the child cope with pain.

See also

Related Research Articles

<span class="mw-page-title-main">Ramsay Hunt syndrome type 2</span> Presentation of shingles in the geniculate ganglion

Inflammation of the geniculate ganglion of the facial nerve is a late consequence of varicella zoster virus (VZV) known as Ramsay Hunt syndrome (RHS), commonly known as herpes zoster oticus. In regard to the frequency, less than 1% of varicella zoster infections involve the facial nerve and result in RHS. It is traditionally defined as a triad of ipsilateral facial paralysis, otalgia, and vesicles close to the ear and auditory canal. Due to its proximity to the vestibulocochlear nerve, the virus can spread and cause hearing loss, tinnitus (hearing noises that are not caused by outside sounds), and vertigo. It is common for diagnoses to be overlooked or delayed, which can raise the likelihood of long-term consequences. It is more complicated than Bell's palsy. Therapy aims to shorten its overall length, while also providing pain relief and averting any consequences.

<span class="mw-page-title-main">Shingles</span> Viral disease caused by the varicella zoster virus

Shingles, also known as herpes zoster, is a viral disease characterized by a painful skin rash with blisters in a localized area. Typically the rash occurs in a single, wide mark either on the left or right side of the body or face. Two to four days before the rash occurs there may be tingling or local pain in the area. Other common symptoms are fever, headache, and tiredness. The rash usually heals within two to four weeks; however, some people develop ongoing nerve pain which can last for months or years, a condition called postherpetic neuralgia (PHN). In those with poor immune function the rash may occur widely. If the rash involves the eye, vision loss may occur.

<span class="mw-page-title-main">Wisdom tooth</span> Large tooth at the back of the human mouth

The third molar, commonly called wisdom tooth, is the most posterior of the three molars in each quadrant of the human dentition. The age at which wisdom teeth come through (erupt) is variable, but this generally occurs between late teens and early twenties. Most adults have four wisdom teeth, one in each of the four quadrants, but it is possible to have none, fewer, or more, in which case the extras are called supernumerary teeth. Wisdom teeth may become stuck (impacted) against other teeth if there is not enough space for them to come through normally. Impacted wisdom teeth are still sometimes removed for orthodontic treatment, believing that they move the other teeth and cause crowding, though this is not held anymore as true.

<span class="mw-page-title-main">Herpangina</span> Medical condition

Herpangina, also called mouth blisters, is a painful mouth infection caused by coxsackieviruses. Usually, herpangina is produced by one particular strain of coxsackie virus A, but it can also be caused by coxsackievirus B or echoviruses. Most cases of herpangina occur in the summer, affecting mostly children. However, it occasionally occurs in adolescents and adults. It was first characterized in 1920.

<span class="mw-page-title-main">Aphthous stomatitis</span> Common condition of mouth ulcers

Aphthous stomatitis, or recurrent aphthous stomatitis (RAS), is a common condition characterized by the repeated formation of benign and non-contagious mouth ulcers (aphthae) in otherwise healthy individuals. The informal term canker sore is also used, mainly in North America, although it may also refer to other types of mouth ulcers. The cause is not completely understood but involves a T cell-mediated immune response triggered by a variety of factors which may include nutritional deficiencies, local trauma, stress, hormonal influences, allergies, genetic predisposition, certain foods, dehydration, some food additives, or some hygienic chemical additives like SDS.

<span class="mw-page-title-main">Deciduous teeth</span> First set of teeth in diphyodonts

Deciduous teeth or primary teeth, also informally known as baby teeth, milk teeth, or temporary teeth, are the first set of teeth in the growth and development of humans and other diphyodonts, which include most mammals but not elephants, kangaroos, or manatees, which are polyphyodonts. Deciduous teeth develop during the embryonic stage of development and erupt during infancy. They are usually lost and replaced by permanent teeth, but in the absence of their permanent replacements, they can remain functional for many years into adulthood.

<span class="mw-page-title-main">Glossitis</span> Medical condition

Glossitis can mean soreness of the tongue, or more usually inflammation with depapillation of the dorsal surface of the tongue, leaving a smooth and erythematous (reddened) surface,. In a wider sense, glossitis can mean inflammation of the tongue generally. Glossitis is often caused by nutritional deficiencies and may be painless or cause discomfort. Glossitis usually responds well to treatment if the cause is identified and corrected. Tongue soreness caused by glossitis is differentiated from burning mouth syndrome, where there is no identifiable change in the appearance of the tongue, and there are no identifiable causes.

<span class="mw-page-title-main">Herpetic whitlow</span> Medical condition

A herpetic whitlow is a herpes lesion (whitlow), typically on a finger or thumb, caused by the herpes simplex virus (HSV). Occasionally infection occurs on the toes or on the nail cuticle. Herpes whitlow can be caused by infection by HSV-1 or HSV-2. HSV-1 whitlow is often contracted by health care workers that come in contact with the virus; it is most commonly contracted by dental workers and medical workers exposed to oral secretions. It is also often observed in thumb-sucking children with primary HSV-1 oral infection (autoinoculation) prior to seroconversion, and in adults aged 20 to 30 following contact with HSV-2-infected genitals.

<span class="mw-page-title-main">Teether</span> Toy for teething babies to chew on

A teether, teething toy, or chew toy is a device given to teething infants. Teether is evolving not only for a baby but also for adults. It has the effect of reducing the pain of irritable wisdom teeth. Most modern teethers are silicone, but can also be made of wood or rubber. Some teethers are filled with a fluid or gel that can be frozen or refrigerated. They differ from pacifiers in that they are intended to be chewed, rather than sucked on. They come in a variety of different shapes. Teethers may help relieve teething pain and help new teeth penetrate the gum, as well as provide a form of entertainment. Studies found that chewing a teether may make teething children calmer and happier, less stressed, and less cranky. Teething necklaces and teething bracelets may pose a choking hazard to infants and toddlers depending on the teething parts, and have prompted recalls. Teethers filled with liquid have also been recalled because of bacterial contamination. Early teethers were often teething rings.

<span class="mw-page-title-main">Herpetic gingivostomatitis</span> Medical condition

Gingivostomatitis is a combination of gingivitis and stomatitis, or an inflammation of the oral mucosa and gingiva. Herpetic gingivostomatitis is often the initial presentation during the first ("primary") herpes simplex infection. It is of greater severity than herpes labialis which is often the subsequent presentations. Primary herpetic gingivostomatitis is the most common viral infection of the mouth.

<span class="mw-page-title-main">Pericoronitis</span> Inflammation of the soft tissues surrounding the crown of a partially erupted tooth

Pericoronitis is inflammation of the soft tissues surrounding the crown of a partially erupted tooth, including the gingiva (gums) and the dental follicle. The soft tissue covering a partially erupted tooth is known as an operculum, an area which can be difficult to access with normal oral hygiene methods. The hyponym operculitis technically refers to inflammation of the operculum alone.

<span class="mw-page-title-main">Genital herpes</span> Infection by herpes simplex viruses of the genitals

Genital herpes is a herpes infection of the genitals caused by the herpes simplex virus (HSV). Most people either have no or mild symptoms and thus do not know they are infected. When symptoms do occur, they typically include small blisters that break open to form painful ulcers. Flu-like symptoms, such as fever, aching, or swollen lymph nodes, may also occur. Onset is typically around 4 days after exposure with symptoms lasting up to 4 weeks. Once infected further outbreaks may occur but are generally milder.

<span class="mw-page-title-main">Tooth eruption</span> Process in tooth development

Tooth eruption is a process in tooth development in which the teeth enter the mouth and become visible. It is currently believed that the periodontal ligament plays an important role in tooth eruption. The first human teeth to appear, the deciduous (primary) teeth, erupt into the mouth from around 6 months until 2 years of age, in a process known as "teething". These teeth are the only ones in the mouth until a person is about 6 years old creating the primary dentition stage. At that time, the first permanent tooth erupts and begins a time in which there is a combination of primary and permanent teeth, known as the mixed dentition stage, which lasts until the last primary tooth is lost. Then, the remaining permanent teeth erupt into the mouth during the permanent dentition stage.

Oral and maxillofacial pathology refers to the diseases of the mouth, jaws and related structures such as salivary glands, temporomandibular joints, facial muscles and perioral skin. The mouth is an important organ with many different functions. It is also prone to a variety of medical and dental disorders.

The central nervous system (CNS) controls most of the functions of the body and mind. It comprises the brain, spinal cord and the nerve fibers that branch off to all parts of the body. The CNS viral diseases are caused by viruses that attack the CNS. Existing and emerging viral CNS infections are major sources of human morbidity and mortality.

<span class="mw-page-title-main">Herpes</span> Viral disease caused by herpes simplex viruses

Herpes simplex, often known simply as herpes, is a viral infection caused by the herpes simplex virus. Herpes infections are categorized by the area of the body that is infected. The two major types of herpes are oral herpes and genital herpes, though other forms also exist.

Neonatal herpes simplex, or simply neonatal herpes, is a herpes infection in a newborn baby caused by the herpes simplex virus (HSV), mostly as a result of vertical transmission of the HSV from an affected mother to her baby. Types include skin, eye, and mouth herpes (SEM), disseminated herpes (DIS), and central nervous system herpes (CNS). Depending on the type, symptoms vary from a fever to small blisters, irritability, low body temperature, lethargy, breathing difficulty, and a large abdomen due to ascites or large liver. There may be red streaming eyes or no symptoms.

<span class="mw-page-title-main">Cold sore</span> Herpes simplex virus infection of the lip

A cold sore is a type of herpes infection caused by the herpes simplex virus that affects primarily the lip. Symptoms typically include a burning pain followed by small blisters or sores. The first attack may also be accompanied by fever, sore throat, and enlarged lymph nodes. The rash usually heals within ten days, but the virus remains dormant in the trigeminal ganglion. The virus may periodically reactivate to create another outbreak of sores in the mouth or lip.

<span class="mw-page-title-main">Dental trauma</span> Medical condition

Dental trauma refers to trauma (injury) to the teeth and/or periodontium, and nearby soft tissues such as the lips, tongue, etc. The study of dental trauma is called dental traumatology.

Oral manifestations of systematic disease are signs and symptoms of disease occurring elsewhere in the body detected in the oral cavity and oral secretions. High blood sugar can be detected by sampling saliva. Saliva sampling may be a non-invasive way to detect changes in the gut microbiome and changes in systemic disease. Another example is tertiary syphilis, where changes to teeth can occur. Syphilis infection can be associated with longitudinal furrows of the tongue.

References

  1. ↑ Lunt Roger C., Law David B. (October 1974). "A review of the chronology of eruption of deciduous teeth". The Journal of the American Dental Association . 89 (4): 872–879. doi:10.14219/jada.archive.1974.0484. PMID   4609369.
  2. ↑ "Teething". National Health Service of England
  3. ↑ Massignan, Carla; Cardoso, Mariane; Porporatti, André Luís; Aydinoz, Secil; Canto, Graziela De Luca; Mezzomo, Luis Andre Mendonça; Bolan, Michele (March 2016). "Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis". Pediatrics. 137 (3): e20153501. doi: 10.1542/peds.2015-3501 . PMID   26908659.
  4. 1 2 3 L Jaber; I J Cohen; A Mor (1992). "Fever associated with teething". Archives of Disease in Childhood. 67 (2): 234. doi:10.1136/adc.67.2.233. PMC   1793425 . PMID   1543387.
  5. ↑ Teething Overview WebMD. Retrieved on 2010-01-25
  6. ↑ Macknin, Michael L.; Piedmonte, Marion; Jacobs, Jonathan; Skibinski, Christine (2000-04-01). "Symptoms Associated With Infant Teething: A Prospective Study". Pediatrics. 105 (4): 747–752. doi:10.1542/peds.105.4.747. ISSN   0031-4005. PMID   10742315. S2CID   24601644.
  7. ↑ When do Babies Start Teething? Kute Keiki. Retrieved on 2019-09-15
  8. ↑ Infant and toddler health Mayo Clinic. Retrieved on 2010-01-25
  9. ↑ Teething Symptoms eMedicine Health Portal. Retrieved on 2010-01-25
  10. ↑ Maheswari, N. Uma; Kumar, B. P.; Karunakaran; Kumaran, S. Thanga (August 2012). ""Early baby teeth": Folklore and facts". Journal of Pharmacy & Bioallied Sciences. 4 (Suppl 2): S329–S333. doi:10.4103/0975-7406.100289. ISSN   0976-4879. PMC   3467875 . PMID   23066283.
  11. ↑ Tintinalli, Judith (2004). Emergency Medicine: A Comprehensive Study Guide (6th ed.). McGraw-Hill Professional. p. 1483. ISBN   0-07-138875-3.
  12. 1 2 Owais AI, Zawaideh F, Bataineh O (2010). "Challenging parental myths regarding their children's teething". International Journal of Dental Hygiene. 8 (1): 28–34. doi:10.1111/j.1601-5037.2009.00412.x. PMID   20096079.
  13. ↑ MacKnin ML, Piedmonte M, Jacobs J, Skibinski C (2000). "Symptoms associated with infant teething: A prospective study". Pediatrics. 105 (4 Pt 1): 747–752. doi:10.1542/peds.105.4.747. PMID   10742315. S2CID   24601644.
  14. 1 2 King DL, Steinhauer W, García-Godoy F, Elkins CJ (1992). "Herpetic gingivostomatitis and teething difficulty in infants". Pediatric Dentistry. 14 (2): 82–85. PMID   1323823.
  15. ↑ "Primary Herpetic Gingivostomatitis In Children". Drugs.com. Retrieved December 18, 2011.
  16. ↑ Zerr, Danielle M.; Meier, Amalia S.; Selke, Stacy S.; Frenkel, Lisa M.; Huang, Meei-Li; Wald, Anna; Rhoads, Margaret P.; Nguy, Long; et al. (2005). "A Population-Based Study of Primary Human Herpesvirus 6 Infection". New England Journal of Medicine. 352 (8): 768–76. doi: 10.1056/NEJMoa042207 . PMID   15728809.
  17. ↑ McIntyre GT, McIntyre GM (2002). "Teething troubles?". British Dental Journal. 192 (5): 251–5. doi: 10.1038/sj.bdj.4801349 . PMID   11924952. Citing King DL (1994). "Teething revisited". Pediatric Dentistry (16): 179–182.
  18. ↑ Davis, Jeanie Lerche. "Teething vs. Illness: How to Tell the Difference". WebMD . Retrieved 14 October 2015.
  19. ↑ "Can Teething Cause Fever?". Kute Keiki. Retrieved 21 March 2023.
  20. ↑ "Press Announcements - FDA warns about safety risks of teething necklaces, bracelets to relieve teething pain or to provide sensory stimulation". FDA. Retrieved 21 December 2018.
  21. ↑ "FDA Drug Safety Communication: Reports of a rare, but serious and potentially fatal adverse effect with the use of over-the-counter (OTC) benzocaine gels and liquids applied to the gums or mouth". U.S. Food and Drug Administration. April 7, 2011. Retrieved December 18, 2011.
  22. 1 2 Tsang, Annetta K. L. "Teething, teething pain and teething remedies". International Dentistry – Australian Edition. 5 (4): 18.
  23. 1 2 3 Tsang, Annetta K. L. "Teething, teething pain and teething remedies". International Dentistry – Australian Edition. 5 (4): 23.
  24. ↑ "Medications used to treat teething pain". '"eMedicine MedicineNet. Retrieved 25 January 2010.
  25. ↑ Karri, SK; Saper, RB; Kales, SN (2008). "Lead encephalopathy due to traditional medicines". Current Drug Safety. 3 (1): 54–59. doi:10.2174/157488608783333907. PMC   2538609 . PMID   18690981.
  26. 1 2 Dally, Ann (1996). "The lancet and the gum-lancet: 400 years of teething babies". The Lancet. 348 (9043): 1710–1. doi:10.1016/S0140-6736(96)05105-7. PMID   8973438. S2CID   44988884.
  27. ↑ Dally, A. (1997). "The Rise and Fall of Pink Disease". Social History of Medicine. 10 (2): 291–304. doi:10.1093/shm/10.2.291. PMID   11619497.
  28. ↑ OED ; Examples from the Metropolitan
  29. ↑ "Rattles". Victoria & Albert Museum of Childhood. Retrieved December 18, 2011.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.