Effectiveness/General Use

Do they really work or is it a mind over matter thing?

I think that there are probably some uses for oils that will be studied and proven to work. I think these will be pretty rare and only a small fraction of the claims that are currently made.

So, is it mind of matter (placebo)? Here are some of the most common uses I see for oils in kids:

Teething - It’s not even clear what symptoms teething causes …fussiness, fever, runny nose, etc have all come into question. But, if you give an oil and a symptom goes away, does that mean the oil fixed it? Not likely.

Fever - Fevers come and go during the day with illness, even without medication.

Cough/congestion - The regimens I see where children have oils placed frequently basically make it impossible to know if they do anything for these symptoms. Cough/congestion will be worse at certain times of day and better at others treatment or no.

How close are we to having actual research on the use of oils?

I still think we are quite some time away. Those that are currently doing research are often biased, are not doing high-quality studies and are using small sample sizes.

Marketing

Why are they sold through multi-level marketing (MLM)?

It’s a fast way to get a product out there and make a lot of money. Since I’ve been on social media, I’ve seen several of these types of MLM ideas crop up. The difference with these is I have some specific knowledge about the conditions they are being used for and specific concerns about how their use could harm a population of people that I care very much about. I know very little about bags and good smelling wax that can be melted with a light-bulb so I haven’t gotten involved until now.

In many ways, it protects the big company because they are not the ones out there making claims about the oils and what they can do. That falls to their independent distributors. If someone were to have a bad outcome because of their use of essential oils, who is responsible? If I prescribe a medicine that someone is allergic to, that responsibility falls squarely on my shoulders, not the makers of amoxicillin. If I prescribe the wrong medicine for a kids asthma and something bad happens, that responsibility falls to me.

Are they an increasingly popular trend or just something I was not aware of?

I’m not sure but it certainly does feel like they are gaining in popularity. Social media makes it seem that way at least.

Do you believe the claim that certain brands of oils are superior to others?

I’m sure there are differences but since we don’t even know what they do for the most part, it’s hard to answer this question.

Philosophy/Opinion

Regarding writing about essential oils: Are you mad, man?

Yes, in fact, I think I must be.

What’s the number one reason you see parents using oils instead of medicine?

In general, people are becoming less trusting of experts and organized institutions. Medicine and doctors are no different. The gap between what a doctor knows and what patients know shrinks every day. People can find out information about their conditions and know basically the treatment options that exist. People are looking to live more natural lives and most who use them feel that oils fit within that idea. When you combine these two issues, right or wrong, essential oils seem to step in the gap.

What is a good way to communicate with your doctor about your use of essential oils (for specific conditions and generally)?

I think it’s important to be honest with you doctor about your use of essential oils. As new information is uncovered it would be important for your doctor to be able to show you new research etc, especially if something shows a particular oil to be unsafe. They can only do this if they know about your use of them. Also, as doctors are prescribing medications, we need to know anything you might be on that could cause a drug interaction.

What is your take on the potential political barriers to the study of essential oils given that they are not backed by super profitable pharmaceutical companies?

Young Living is a very profitable company. They are big and profitable and will only continue to be more profitable. There is no reason that they could not start testing their own products or set up independent testing.

After your research as a pediatrician, would you use them on your children?

People will read all of this information or even do further research and come to different conclusions from me but here are two reasons I won’t:

1. I do not treat my kids with unnecessary medications. Since they are recommended for symptoms and given with the hopes of reliving those symptoms, I consider these oils to be medication.

2. I believe that, due to the lack of good studies, the use of them in children should be considered experimental at this point.

Summary

• The use of essential oils seems to be growing.
• The evidence for their use in children is slim.
• Talk with your doctor about the products you are using so that they can be aware of potential safety issues and medication interactions. 

Previous articles on this topic:

• New York Times Report: Are Essential Oils Safe For Kids?
• Essential oils and their use on children
• How safe are essential oils for children?

I know Serena, babies are hard to read. As I read Serena Williams' tweets and the struggles she's going through with her baby my heart went out to her.

There were times in my own parenting journey where I wasn’t quite sure that everything I had been teaching my patients for years was actually the right thing. So, pediatricians aren’t immune to a little doubt when the going gets tough.

As Serena Williams discovered over the weekend, celebrities aren’t immune to this either. Apparently her 3 month old was having a REALLY fussy day. And, no doubt, those days are hard. You feel helpless. You’re sure that something is terribly wrong. You want to attribute it to something and you want to have something that will fix it. But…it doesn’t always work out that way.

https://twitter.com/serenawilliams/status/942435383027097600

I guess it didn’t get any better from there…

https://twitter.com/serenawilliams/status/942435460948922368

Of course, she got some suggestions.

Many of which have been shown to be useless (and might even be dangerous) such as: teething gels, homeopathic teething tabs and amber necklaces.

But, the best advice she received came from a friend of mine, a pediatrician from down in Austin, Dr. Ari Brown (@baby411):

https://twitter.com/baby411/status/942613460273238016

Because Dr. Brown is right, teething does get blamed for fever, diarrhea, fussiness, vomiting, diaper rash, sleep disturbance, poor eating, extra eating….I could keep going but instead here’s a post about 4 teething myths.

The reality is that babies most cut their first teeth after 6 months of age and they don’t show signs or symptoms of teething for 3-4 months. If they show any signs, it’s the day before and the day that the tooth erupts and even that is up for debate.

So, what could be the cause of your child’s “teething” symptoms? Here are 3 things to consider:

1. Viral illnesses-Because viruses can cause fever, rash, runny nose, diarrhea and a number of other symptoms for which teething is often blamed, they are a common cause of visits to my office for a concern of “teething.” Because viruses are self-limited (they go away on their own), they will resolve in 3-5 days which just further reinforces the idea in parent’s minds that the symptoms were due to teething.

2. Ear infections-It’s possible for children to have ear infections, even at early ages. Because fussiness and disrupted sleep are common symptoms of ear infection, they are often mistaken for teething. Especially if your child has fever and upper respiratory symptoms along with their fussiness, consider ear infection a possible cause.

3. Normal development-This is the least popular of my opinions on teething but I believe it is probably the most accurate. I think it is normal for babies to have periods of fussiness and sleep disruption. Just like we have bad days and just like we have nights where we don’t sleep as well, babies can too.

Because of that, here was my advice:

https://twitter.com/TheDocSmitty/status/942618451788615681

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.

Every kid goes though it and yet, it’s universally misunderstood. Poor teething. It gets blamed for just about everything and probably causes very few symptoms.

I thought I would clear up some of these misconceptions and I asked Sheela Patel, D.D.S, a pediatric dentist at CookChildren’s to lend her expertise.

Teething Myth No. 1- Teething causes fever (or maybe you’ve heard it blamed for congestion, sleep disturbance, decreased appetite, diaper rash, diarrhea or vomiting).

It doesn’t. Right, Dr. Patel?

“Despite what you may have heard, teething doesn’t directly cause a high fever or even diarrhea,” Dr. Patel said. “Babies tend to put everything in their mouth in an effort to massage their gums, so they may pick up bacteria.”

Here are some symptoms that have been found to be statistically associated with teething:

• Mild temperature increase
• Sleep disturbance
• Salivation
• Rash
• Runny nose
• Appetite loss
• Irritability

You’re thinking, “See, I told you it does cause fever!”

Not so fast.

First of all, the temperature increase was noted to be 0.12 degrees Fahrenheit on the day that the tooth erupted. I’ll leave it up to you to decide if you think having a temperature of 98.6 vs. 98.72 actually makes a difference…

Second, the increase in temperature and the rest of the symptoms associated were found to be present on the day the tooth came and the day after. This was not a 2 week (or 2 month) process leading up to the teeth popping through.

The issue is that all kids teeth. In addition, all kids have occasional sleep disturbances, drool and have runny noses. Trying to determine if the teething causes these symptoms in a particular child is pretty difficult.

Teething Myth No. 2 - It’s too early for them to cut teeth.

The average age for the bottom middle teeth to come out is 4-6 months, but some children teeth before or after.

Some children are born with teeth, called natal teeth. If the teeth are stable in the mouth, nothing needs to be done. There may need to be some extra special care with breastfeeding moms to make sure their latch is not painful, especially during those early feeding days. If the teeth are wiggly, sometimes the pediatrician will pull it or recommend that you see a pediatric dentist to have it pulled.

Teeth can otherwise erupt any time after birth. But remember that the “symptoms of teething” that occur for two months before a tooth erupts are not likely due to teething at all.

Teething Myth No. 3 - They are too old to not have any teeth.

“He still doesn’t have any teeth.” I get this comment all the way from 6 months to 1 year. The right answer, “That’s OK.”

It is exceedingly rare for children to not have any teeth or to have teeth, but for them to never come out. A handful of babies don’t have teeth at their one year check-up but, I promise, they’re coming.

Teething Myth No. 4 - Teething must be treated.

The understanding of teething has changed a lot over time. Infant death used to be commonly associated with teething. Think about it, if a 6-12 month old child died for unexpected reasons, chances are they had a tooth coming in. Because of this, teething used to be treated with things as invasive as lancing the gums in order help them come through.

While we’ve come far enough to know that isn’t necessary. Parents still attribute a significant amount of normal fussiness or waking up at night to teething and treat based on this idea. What’s the problem? Everything we do has potential risks…from teething gels, to essential oils and even Tylenol^® or Motrin^®, while options, should be used with caution. (While I’m on my soapbox, just because something is the “natural” or “organic” variety, doesn’t mean it’s safe.)

For treatment of teething, Dr. Patel recommends that you “provide a firm rubber teething ring to chew on, but avoid the ones that are filled with liquid. Try giving your child a cool, wet washcloth to chew on. You can wet a washcloth, ring out the excess water and place it in the freezer. Make sure to wash it before each use. Give your child cool, softer foods such as applesauce or yogurt.”

Don’t let these common teething myths fool you. If your child has severe symptoms, don’t attribute them to teething. Don’t treat normal behavior with medication. Don’t assume that teething treatments are without risk.

About Sheela Patel, D.D.S

Dr. Patel is a dentist at Cook Children's Neighborhood Clinic on 2600 E. Berry Street in Fort Worth Texas, 76105. Dr. Patel received her dental degree in 2009 from University of Nebraska-Medical Center in Lincoln, Neb. She completed her pediatric residency in 2011 from the Baylor College of Dentistry in Dallas. Dr. Patel is board certified by the American Academy of Pediatric Dentistry. The Neighborhood Clinic offers a dental home for patients from 6-18 years of age the clinic and most CHIP, Medicaid, and commercial insurance plans are accepted. The staff speaks English and Spanish. To learn more, click here or call 817-347-4600.

What if you then found out that you had been lied to about that day care’s license?

In fact, they didn’t have a license at all.

Fortunately cases like this are rare.

But what about a more common case where your child is bitten once or a few times at day care? What if your child is the one who is biting?

I reviewed the Texas Department of Family and Protective Services Minimum Standards for Child-Care Centers. Here is what I found:

• Parents should be notified about minor injuries when the child is picked up from day care (biting is included in this category).
• Relevant ongoing education is required for employees (and specifically mentions biting).
• Decisions about child/caregiver ratio must take into account situations where there are tricky situations. For biting, it suggests that a caregiver be assigned with training in redirection or that an extra caregiver be assigned.
• Biting is specifically prohibited as a means of discipline for a child (day care workers cannot use the old “just bite them back” techniques for biting).

What can you do?

Three tips if your child is being bit:

1. If it’s a one-time thing, try your best to let it go. I know this is hard but biting does happen and can happen in the blink of an eye even in very closely supervised environments.
2. If you start to notice bites over time, mention your concerns and assess what the day care is doing to prevent the issue.
3. If the bites are severe or very frequent, I would feel very confident suggesting that your child’s day care follow the steps as outlined in the Child Care Guidelines. This might mean that the day care needs a specialized or extra caregiver for the “problem” room.

Three tips if your child is the biter:

1. Do not feel guilty. Sometimes the day care will make it seem like your parenting is the problem. The reality is that you cannot do anything at home to teach a toddler to not bite at day care. Discipline in the toddler age does not work that way.
2. Discuss your child’s triggers with the day care. Biting usually occurs in predictable situations for children. You might be able to help them prevent biting in the first place.
3. Learn what works to distract your child. Children need to be distracted when they are biting. It’s clear from studies that direct punishment does not work well with toddlers. Teach the day care what strategies they can use.

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.

Well, it is not from teething but it could be from the treatment you are using for it.

Fever, congestion, diarrhea, fussiness, putting things in their mouth, not sleeping well, you name it and someone has attributed it to teething.

So how do you treat the pain associated with teething?

There are lots of products available most of which are not helpful and can be potentially harmful.

Avoid products with benzocaine and lidocaine (oragel and other gels). These have been known to cause a problem in babies called methemoglobinemia where your child will turn BLUE. I mean smurf crazy blue and is obviously a medical emergency. Also, avoid products with belladonna (teething tabs) as this has known to be poisonous and doesn’t have studies proving that it decreases pain anyway.

This quote comes from the healthychildren.org article on teething (click to see full article):

“To ease your baby’s discomfort, try gently rubbing or massaging the gums with one of your fingers. Teething rings are helpful, too, but they should be made of firm rubber. The teethers that you freeze tend to get too hard and can cause more harm than good.) Pain relievers and medications that you rub on the gums are not necessary or useful since they wash out of the baby’s mouth within minutes. Some medication you rub on your child’s gums can even be harmful if too much is used and the child swallows an excessive amount.”

So what symptoms really do come up before babies cut their teeth? When can we expect teeth to erupt? What can we do for our children when they are teething?

The best study I have found about teething was done in 2000 and included lots of kids and 475 tooth eruptions. Click here to see the study.

The symptoms that they found to be associated with teething were the following:

• Biting
• Drooling
• Gum-rubbing
• Sucking
• Irritability
• Wakefulness
• Ear-rubbing
• Facial rash
• Decreased appetite for solid foods
• Mild temperature elevation

The following symptoms were NOT associated with teething:

• Congestion
• sleep disturbance
• stool looseness or increased stool number
• Decreased appetite for liquids
• Cough
• Rashes other than facial rashes
• Fever over 102 degrees F
• Vomiting

I have seen some studies that will include congestion in the symptom list for teething. I think one of the main misconceptions is about fever. I commonly have parents ask if 102-103 temp could be caused by teething and the studies are pretty clear that if the fever is that high, it probably isn’t just teething.

If our children are particularly fussy from teething, we will occasionally use Tylenol^® and if more than 6 months old Motrin^® according to weight appropriate dosing sporadically for a day or 2 until symptoms subside.

The main thing is that you have to be flexible with your child and allow them a little extra grace for changes in sleep and feeding habits. Teething is normal and should be consider a normal developmental stage. It can be disruptive to schedules and the extra fussiness can make things stressful. Hang in there, this phase is temporary.

Related article:

4 teething myths every parent should know