Reader's question: Teething and sleeping... not so much

Several of you have written to me about teething and how it can mess with any hopes of sleep training (or how teething has disrupted already healthy established sleep patterns). Here's one example of the emails about this topic:

We have a 6month old daughter whose reflux is now on the wane, and who seems to have had either a stomach bug, colds, or teething pain since she was about 2.5months old. One just melted into the other and we have come to the point where she has to be rocked to sleep, and now that we are going through the second round of teething, she's been waking up sometimes every 1 - 1.5 through the night.

My main question is how to deal with teething / colds. The little I have found on the subject of teething/sleeping online says that a) teething disrupts sleep, b) wait for teething to pass. But because our little one always seems to have something going on, I fear that if we wait for this round of teething to pass, something else will come up and then we'll be in the no-no time zone and even worse off than we are now. I also go back to work in three months and am dreading those nights already.

Do you have any suggestions about teething / sleep training?

Before I had kids of my own, I was convinced that one the most serious design flaws ever to emerge from our evolutionary history was being born without teeth. Why on earth would babies be born with sweet, gummy mouths and then have to painstakingly grow each and every tooth, one by one, in excruciating anguish?! Why don't infants just pop out with a full set of pearly whites? Then I started nursing my twin boys and it all became soooooooooo clear. Actually, my "aha" moment came when my peacefully-nursing 8-month old clamped down on my boob so hard that he left some serious marks. Yeah. I get it now.

Teething is a funny thing when you start talking to parents about it. There is no doubt that it's one of the most common reasons for sleep setbacks and disruptions and it certainly can mess with any sleep- training plans. There is a fascinating amount of variation among babies in terms of how much pain they actually experience during teething episodes. You talk to some parents and teething is the #1 most under-appreciated parenting (and infant) challenge they have ever experienced. They talk about watching their children's pain with such horror and pain themselves. Other parents? They can't see what the big deal is; they didn't even notice when Johnny got his last 10 or so teeth. Although I'm no physician and this is most definitely not my area of expertise (I'm happy to hear from anyone that knows more about this), I haven't come across any good research on what might cause this huge difference among children's teething experiences. Some pediatricians have had the gall to suggest to me that teething doesn’t actually cause pain, it just “seems” like that to us; some tell us that often parents attribute "bad moods" to teething in general (I can't tell you how hard I wanted to deck my ped when he offered this nugget of insight while my 4-month old was gnawing on his fist, sobbing and screeching all the while. And I can't tell you how righteous I felt when the poor boy cut his first tooth 2 days later, "way before kids get their first teeth"). Most parents, however, have had the heartbreaking feeling of watching a young infant or child wail through a teething episode, rubbing their gums like mad and biting on anything that passes their way. 

Teething can disrupt sleep for the obvious reason: pain is difficult to sleep through. But teething is also often accompanied by a runny nose, fever, congestion, coughing from all the drool that gets stuck in the back of the throat, and rashes around the mouth or anal area; all very difficult symptoms to fall asleep and stay asleep with!  Teething episodes can last as short as one day to as long as many weeks.  Diagnosing the problem can be critical for your sanity and, importantly, for helping your child through this difficult period by providing pain relief and emotional support.

But you all probably know that. How can you sleep-train through these episodes? Should you? Is it better to wait it out with the potential of getting into a dicey stage transition after the teething subsides? All I can offer are some of my thoughts, no real answers here:

• Sometimes, children with well-established sleep habits can and do put themselves to sleep right after bursts of pain. From my experience and other moms I know, teething often happens in bursts, so the pain doesn't last for hours at one time (although the bouts may come one after another for hours).The skill to put oneself to sleep can be a blessing for these kids, because they escape the post-pain anxiety that often comes AFTER the pain recedes. In other words, sometimes kids continue to cry even after the major bout of pain has subsided because they're afraid of the impact of the next bout. If they can put themselves to sleep quickly, they might be able to avoid this extra distress.
• If you do want to sleep-train during a teething period because EVERY month is a teething period or the child has a cold or you're traveling or... SOMETHING, then you might want to avoid any sleep-training method that requires prolonged stretches of letting the child cry. Gentle sleep-training methods that encourage you to help the child fall asleep gradually on her own without crying will help you read your child's signals better. In contrast, if you use a cry-it-out method, it will be very difficult for you to distinguish between when the child needs you to help him deal with intense physical pain vs when she is simply crying because she wants you present and/or she doesn't want to go to sleep.
• Obviously, pain medication can be a huge help if you ARE sleep training during teething episodes.
• If you're in a good developmental window for sleep training and the only obstacle you're facing is teething, there is no harm in trying to implement your favourite sleep-training method and just see how it goes. If after 3 or so days nothing is improving and you're finding it confusing to read your child's signals of distress, quit and try again next week. Teething bouts ebb and flow and some weeks they are less intense than others (at least for some children; some others never seem to feel relief until all their teeth have come in).

This is a really, really common problem and I hate when I can't give straightforward advice based on data. But I thought it might be good to just put this issue out there since so many of you are dealing with it and perhaps others can help with some suggestions that have worked for them. Alternatively, remember that development IS like a pendulum and if you miss the next opportune window for sleep-training, another one is coming eventually (little comfort, I know, for a desperately sleep-deprived parent RIGHT NOW).

Words of wisdom or commisseration?

Comments

[Kelly]

Ai, this could have been us. We spent the first 18 months of E's life basically trying to make it from one bout of teething to the next, with the occasional cold to spice things up a bit. It is one of the reasons I decided not to try to sleep train or night wean before her eyeteeth finished at about 18 months. And then I read Bedtiming and realized that I probably should try to wait a bit to sleep train...and sure enough, she went through an intense period of separation anxiety that would have made sleep training just awful. I know because I tried, and it was awful!

I mostly write this not to say that you can't sleep train a bad teether before 23 months, but that some kids (mine) are just *terrible* teethers, and no, it's not you, and I personally think it's okay to do whatever it takes to soothe your child if you think or suspect they are in pain. And we did go through a LOT of baby tylenol/ibuprofen. And homeopathic pills, and anything else we could think of or heard about.

Okay, off to night wean and then sleep train...later this week.

[Isabela]

Thanks for your thoughts, Kelly! And GOOD LUCK next week. Hope things go smoothly for you all...

[Amy Riddle]

Motrin lasts 8 hrs, Tylenol only 4. The worst of sleep training is usually the first few days. I'd medicate those first few days to make sure that I was only dealing with sleep issues.

My guy is 17 months old and goes and gets the oral gel off the night stand when its bad. Honestly I'm horrible at decoding the signs of teething since he's been chewing his fingers for the last month. I don't think he's ever going to cut his molars, some days he's fine and others ugh.

[Isabela]

Amy, I agree with your general advice about medicating the first few days but there are some kids whose teething pain is no match even for Motrin and Tylenol; it may dull it a bit, but they'll still wail through the worst of bouts even medicated. I had no idea this was the case until I saw with my own eyes the intensity of some kids' teething pain.

And yeah, it can be tough for all of us to decode the teething stuff since kids are putting their hands and EVERYTHING in their mouths anyway during their first couple of years.

[fahmi]

My mother told me that kids who are not hungry don't have teething pains (uh-huh...) and we never really noticed when the older child was teething. He was always gumming and sucking his hands, us, anything, but we figured that was because our pinky finger used to be his pacifier for the first four months or so. We didn't know what to look for. With the baby, he is always gumming and chewing and sucking, but lately he's started waking up in the middle of the night to cry inconsolably. And we can't tell if that's teething or too hot (heat wave) or what. So we don't know what to do to get him back to sleep, either.

We were told by many people that it's bad to use orajel on gums, because kids swallow it, and it numbs their throat, and then they can't breathe or swallow and they choke on their saliva. Is this true?

[Isabela]

@fahmi: all I can tell you is that I used orajel with both my boys and it helped ALOT. I'm not a physician, as you know. So I can't speak from that direction of expertise. I can tell you what I thought when I heard some of these claims: yeah, it's probably not ideal that kids WILL definitely swallow it, but there's no freaking way it's strong enough to obliterate any swallowing or breathing reflex (that's a pretty basic and extreme physical response that surely would be noted when tested). I think of it more like the novacaine or whatever they call the stuff that numbs gums at dentists nowadays -- it numbs pain around the mouth and teeth, but certainly doesn't cause suffocation or choking.

All I can tell you is check with your pediatrician. From my experience, the stuff worked well to temporarily help with intense, localized pain in the gums that were clearly swollen, red and irritated.

It's so hard to diagnose these things when so many factors are at play. I hope things get easier for you all very soon...

[Bonnie]

I am _SO_ glad you wrote this post! I was getting infuriated by the book by the author whose name rhymes with "niceboots" saying that teething does not disrupt sleep. He has not been to MY house, where a 2am dose of Motrin every now and then really helps. (Then there are nights when multiple doses do NOT help, and we aren't quite sure what's going on there...) He has obviously not heard my child's miserable "wuh wuh wuh" cries muffled by his hand and his lovey stuffed in his mouth! So, I'm really glad you wrote this one!