Published January 31, 2016 (current as of December 24, 2024)
Many parents like to rub numbing medicine on their baby’s gums to treat the discomfort of teething. There are some over-the-counter (OTC)products, called topical anesthetics, available for this purpose. Examples include Anbesol and Orajel. Benzocaine is the main ingredient in these and many OTC teething products.
One of the safety concerns of using benzocaine products is that it can cause a serious and sometimes fatal condition called methemoglobinemia. This is a blood disorder that prevents the blood from carrying oxygen carried throughout the body. It can occur within minutes after applying a benzocaine product, even after the first time it is used. It doesn’t happen very often overall, but children 2 years old and younger appear to be at particular risk.
Another problem with using teething products is that young children, especially babies, will swallow the medicine. If this happens, the throat may become numb, and the baby could have difficulty sensing liquids during swallowing. This can increase the risk of choking or aspiration (food or liquid going down the airway).
In 2011, the US Food and Drug Administration (FDA)issued an alert about the risks of benzocaine gels. The FDA stated these products should not be used except when ordered by a doctor. The American Academy of Pediatrics also discourages topical pain medicine use in infants.
There are also prescription numbing products that are used to reduce gagging when taking X-rays of the mouth or making dental impressions. Lidocaine oral solution (called viscous lidocaine 2%) is one example. Doctors often prescribe this type of numbing medicine for cancer patients who have mouth ulcers from the chemotherapy medicine they receive. Unfortunately, some doctors have also prescribed this medicine to treat teething pain. Because of safety concerns, FDA has NOT approved this product for children who are teething. Use in infants and young children can cause serious harm, including death.
Some of these products don’t stick to the gums for long. They often wash out pretty quickly and only work for a short time. Then well-meaning parents may use the product more often that recommended by the doctor or the product label. Parents have also been known to put liquid gel forms of a topical anesthetic into a baby’s formula or even soak a pacifier or a cloth in it then put that in their baby’s mouth. These are dangerous practices since it is difficult to determine how much medicine the child receives.
In 2014, we learned about a tragic event involving twin1-year-old babies who were prescribed lidocaine oral solution for teething pain. The first infant had a seizure at home, followed by heart failure. She was successfully revived by emergency personnel and taken to a hospital. Since the infant had been playing with toy beads, the parents and doctors thought the baby had choked on a bead. Just 2 days later, the second twin had a seizure and developed heart failure. Sadly, this twin could not be saved.
Upon hearing of the death of the second twin, concern for exposure and/or ingestion to poisons or medicines in the home was raised. Test results for the first twin indicated high levels of lidocaine in the body. It was learned that the infant’s doctor had prescribed lidocaine oral solution 2%for teething pain and irritability. High levels of lidocaine were also found in the second infant. It is unclear exactly how the infants received an overdose of the medicine.
Here's what you can do: If your infant is experiencing teething pain, try the following:
The bottom line is, lidocaine oral solution and benzocaine gels or liquids should not be used to treat teething pain in young children or infants.
