“You’ll shoot your eye out,” she said.

Toy guns have changed since the release of that 1983 classic depicting a 1940s family. If Ralphie were a kid today, he may have his sights set on a water-based gel blaster—one of the popular toy guns of this generation. And Ralphie’s mom would likely say the same, for good reason.

Any toy with a projectile has the potential to cause an injury, especially to the eye. Dan Guzman, M.D., is a pediatric emergency medicine physician on the medical staff at Cook Children’s Medical Center. He also leads Cook Children’s Aim for Safety initiative, which is designed to reduce injuries through gun safety education. Dr. Guzman recently purchased a gel water ball gun to see for himself what hazards they pose to children. Also known as gel soft guns, these toy shooters are similar in design to airsoft guns, but their bullets are made of biodegradable water-filled beads.

“The bullets feel really squishy,” Dr. Guzman said. “But they’re definitely a projectile, and any projectile to the face or in the eye is going to hurt or may cause some injury. I shot them at a tree to see what they would do. Some of the bullets exploded into nothing, but there were some that seemed to be crystallized and actually turned into smaller projectiles once they exploded, which concerned me a little bit.”

A review of the Consumer Product Safety Commission’s electronic injury surveillance system found more than 6,500 cases of eye trauma from toy guns with projectiles between 2010 and 2019, according to a study published in the journal Investigative Ophthalmology and Visual Science. The most common injury was ocular contusion, better known as a black eye. The most serious wound was an open globe injury. Most of those injured were boys, and more injuries occured in December than any other month of the year.

“I haven't seen a lot of injuries from these gel guns just yet, because I think they are relatively new, but I suspect after the holiday, I will,” Dr. Guzman said.

If Santa leaves a projectile-firing toy gun under your tree, Dr. Guzman has a few tips to help keep your child, and those anywhere near the line of fire, safe from injury.

“I'm not going to tell you you shouldn't have one,” Dr. Guzman said. “But I’m definitely going to tell you how to do it safely to make sure your kid doesn't end up in my ER with some horrible injury where they've lost vision in one of their eyes and they'll never be able to see out of that eye again.”

Wear eye protection. Many manufacturers place this warning on their toy gun products, and some even come with eye protection.

Supervise your child and teen when playing with toy guns. They may not be as life threatening but they do shoot powerful projectiles and can cause significant and life-altering injury. Kids—especially teens—are naturally impulsive and don’t always think through the potential consequences of their actions, like what could happen if you aim at someone’s head, or turn the gun towards your face to look down the barrel, or shoot from too close of a distance.

“We just want people to be safe,” Dr. Guzman said. “With these eye injuries, many recover, but some don’t. You truly could put an eye out and nobody wants to be responsible for that.”

Teach kids to respect the danger. To some degree, toy guns that shoot projectiles, be them water-based gel beads or plastic pellets, need to be treated with the same respect and caution as a real gun. Closely monitoring your child while playing with a toy gun gives you the opportunity to see how they interact with the gun, correct concerning behavior and opens the door for conversations about safety that may translate to real guns.

As an emergency department physician, Dr. Guzman has witnessed first hand the devastation that can occur when a gun isn’t handled or stored properly. That’s what drives his passion for gun safety.

“I want to give families the tools to be able to make a great decision,” he said. “If we’re going to play with a toy gun that shoots a projectile, it’s important to know some basic safety steps to keep the entire family safe. Those key safety points then help to shape the conversation about real guns.”

It’s a good idea to practice the same safety measures with projectile firing toy guns as you would with a real gun. When not in use, toy guns should be stored away where kids can’t freely access them. And if they do happen upon one, be sure they know how to respond.

“That's another key point,” Dr. Guzman explained. “What do you do when you find something like this, even a toy, when you go to a friend's house? You don't just pick it up and start pointing at people and playing with it. They need to know to respect that object so they can respond safely.”

Make sure your child knows to keep toy guns at home. Never take them to school or a public place where they can be mistaken for a real gun.

While we love taking care of our patients, the last place you want to spend your holiday if you can avoid it is in the emergency department. Play smart and be safe. We “triple-dog-dare ya.”

The FDA's lab found inconsist ammounts of belladona, "a toxic substance, in certain homepathic teething tablets, sometimes far exceeding the amount claimed on the label." The agency warns that homepathic teething tablets containing belladonna pose an unnecessary risk to infants and children and urgests consumers not to use the products. 

The FDA contacted Standard Homeopathic Company, the manufacturer of Hyland's homeopathic teething products, to ask for a recall of its homeopathic teething tablets products labeled as containing belledaonna for protection of the users. So far, the company hasn't agreed to a recall, but the FDA is asking parents to stop using these products. 

Homeopathic teething products have not been evaluated or approved by the FDA for safety or effectiveness. The agency is unaware of any proven health benefit of the products, which are labeled to relieve teething symptoms in children. InSeptember 2016, the FDA warned against the use of these products after receiving adverse event reports.

Last year, Buzzfeed News reported that the agency had examined more than 400 adverse event reports and 10 deaths connected to homeopathic products in the last six years.

Please seek medical care immediately, if your child experiences seizures, difficulity breathing, lethargy, excessive sleepineess, muscle weakness, skin flushing, constipation, difficulty urinating or agitation after using homeopathic teething products.

Homeopathic teething products are labeled to treat the pain or irritability associated with teething, however no study has verified their effectiveness. The FDA has previously recalled teething tabs because they contained an inconsistent amount of belladonna. This is important because even small amounts of belladonna could be toxic, even deadly in a child.

Homeopathic medicines are made by taking a potentially active ingredient, such as belladonna, and diluting it thousands and thousands and thousands of times. For instance, the amount of belladonna in a commercially available teething tab is supposed to be: 0.0000000000002mg of Belladonna alkaloids. If you are thinking, “How could that small amount of anything actually do ANYTHING?” You would be right. Those who prescribe, make or sell homeopathic products claim that despite the dilution, the solution continues to maintain an imprint or memory of the original substance. This statement goes against anything that we know about science (or basic common sense for that matter).

So, why are parents still using them? Because babies get fussy and it’s hard and it causes anxiety and you want to fix it. But, can we be sure that teething actually causes any predictable symptoms? It’s difficult to say. Some studies suggest there might be a day or two of fussiness around the time of tooth eruption, but the idea that babies are fussy for months because of teething has not been found to be true. This is one of many teething myths that are out there.

Treating teething symptoms (even if they are real) probably doesn’t work and many teething treatments can cause dangerous side effects … teething gels with benzocaine can cause your baby to turn blue and amber teething necklaces have no plausible explanation for how they might work and could post a strangulation or choking risk. Even treating with acetaminophen or ibuprofen is not risk free.

If you have given teething tabs and notice any side effects such as those mentioned by the FDA report, call your pediatrician immediately. Watch for seizures, difficulty breathing, lethargy, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating or agitation.

If you suspect your baby has teething pain, allow them to chew on their hand or on hard objects for comfort.

No other treatment is required.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the fall of 2016.

You can read my earlier posts on the symptoms of teething and my outright forbidding the use of teething gels.

After these, I think I have many of my readers wondering what in the world they are supposed to do when their child seems to be teething.

There are a select few of you out there who think you have found a loophole … their children are walking around sporting brownish yellow bling around their necks, are as happy as can be at all times and are sleeping through the night like little angels. Right?

Do amber teething necklaces work? If so, how?

Websites selling amber necklaces are all over the place when discussing how they might work to control symptoms that are commonly associated with teething.

They tend to center around three main concepts:

• Magnetism, energy or natural flow of energy

• Thyroid gland stimulation to control drooling

• Succinic acid released causing anti-inflammatory and pain relieving

Magnetism, energy or natural flow of energy

I found this quote in one of the top-ranking articles regarding how amber teething necklaces might treat teething pain:

“The unfavorable environmental conditions prevailing today block the natural flow of energy-related processes in cells. Blocks affect cellular metabolism and significantly weaken the immune system, but the natural energy of amber is able to stimulate its renewal.”

Thyroid gland stimulation to control drooling (or other symptoms)

The thyroid gland makes thyroid hormone which increases metabolism. This results in a whole list of changes inside our bodies, including:

• Increasing body temperature
• Faster, stronger heart beat
• Brain development and growth in children

Slowing drooling is not a function of the thyroid; thus stimulating it would not result in less drooling.

Stimulating the thyroid could result in increased body temperature (which is, ironically, often one of the symptoms of teething that people are trying to treat).

Succinic acid release causing anti-inflammatory and pain relieving

Perhaps the MOST logical explanation (and most often referenced) for why amber teething necklaces might work for teething pain is that amber contains 3-8 percent succinic acid.

Succinic acid is a chemical that is found naturally in the body and is involved in an energy producing chemical cycle known as the Krebs cycle. The basis of the reasoning behind why succinic acid treats teething symptoms is that it is reported to have anti-inflammatory properties.

Let’s look at a few problems with the assumption:

1. I can only find one study that even shows succinic acid to have anti-inflammatory effects. It is almost 30 years old and was published in a journal I have never heard of, in Russian.

2. Assuming succinic acid does treat pain associated with teething, how does the succinic acid get into the child’s body? Amber is fossilized tree resin which is formed under extreme heat and pressure. The Wikipedia article on amber states, “Exposure to sunlight, rain and temperate extremes tends to desintegrate resin, and the process is assisted by micoorganisms such as bacteria and fungi. For resin to survive long enough to become amber, it must be resistent to such forces or be produced under conditions that exlude these." How is it, all of the sudden, that amber decides to release succinic acid in response to 98.6* temperatures and gentle pressure from your child's neck? Seems unlikely.

3. Let’s assume that 1 and 2 are wrong and that succinic does treat pain associated with teething and will absorb into the child’s body from the necklace. How much is absorbed? Medication applied to skin is notoriously unreliable with children.

Let’s flip this around. Say an established drug company comes up with a treatment for a common condition that is not dangerous but may cause some discomfort. The drug rep comes to my office to promote the drug…

Me: Ok, this all sounds great? So, what is the dose? How does the dose change as the child gets older?

Drug rep: Ummmm, we don’t know really. We haven’t really looked into “dosing.”

Me: So, how do you know this works?

Drug rep: Well, it’s actually been around a long time, we just put it in a different package so we’re pretty sure it works and is safe.

Despite the fact that on the surface it seems plausible, I don’t think the succinic acid claim holds up as a mechanism where amber necklaces could work for teething.

Is it a choking hazard?

We have to address these necklaces as a choking hazard. It’s interesting. People say they aren’t a strangulation hazard because they break. Ok. But then they say they aren’t a choking hazard because the beads are tied individually.

I say, you can’t have it both ways. If they break, they have to break somewhere and a bead has to get loose. And if you’ve seen the size of these beads … looks like a choking hazard to me.

So, why do amber teething necklaces “work?”

It’s really based on three points…

1. Teething symptoms are vague and most are only mythically related to teething.

2. Teething symptoms go away on their own 100 percent of the time.

3. Parents are desperate to help when they assume their kids are in pain.

Studies are pretty clear that teething symptoms really only last a day or two around the day that the teeth erupt. Many of the symptoms commonly associated with teething may actually be normal developmental issues-drooling, waking up at night, etc.

Knowing whether a specific treatment for “teething symptoms” works or not is almost impossible. But, for parents who had concerns and tried amber teething necklaces, the results seems magical. Doing something is often thought to be better than doing nothing. It’s certainly easier to brag about.

I have yet to see a Facebook post that says, “My kid was MISERABLE with teething last week but look at him today!! I found the miracle cure - I did absolutely NOTHING! You should try it too.”

I’m coming into a place where I’m not sure treating teething with anything makes sense, even your typical pain relievers. For this reason and because I cannot find a plausible explanation for why they work, I think parents should save their money when it comes to amber teething necklaces.