Which activities are indicative of the teething process in an infant select all that apply

A baby's first teeth usually appear around 4 to 6 months—and these chompers help your child talk and eat solid foods, says Tanny Josen, D.D.S., a pediatric dentist at Kid Island Dental in Long Island, New York. But although teething is an important developmental milestone, it can be painful for babies (and their parents). Here, experts break down the teething process, and they share how to recognize the signs of getting those pearly whites.

Table of Contents Show

Pathophysiology
Statistics and Incidences
Clinical Manifestation
Assessment and Diagnostic Findings
Medical Management
Nursing Management
Practice Quiz: Colic

Your child will grow a full set of 20 teeth between ages 1 and 3—but the process of developing them starts much earlier. Are you wondering how long teething lasts? Check out this baby teething timeline from the womb to toddlerhood.

Tooth Roots: Around the second trimester of pregnancy, tooth buds begin to form under the gums in your baby's mouth. Eventually, the roots begin to grow, forcing the crown up. "The tooth puts pressure on the tissues above it, and they slowly begin to break down," says Michael Hanna, DDS, a spokesman for the American Academy of Pediatric Dentistry. "The tissue gets thinner and thinner until it breaks and the tooth pops through."

Top and Bottom Teeth: The first teeth to come in are usually the two bottom front teeth (central incisors), followed by the four upper teeth (central and lateral incisors). Because these are thinner with a knifelike edge, they often slide through fairly easily.

Molars: Around your baby's first birthday, the first molars will start to arrive in the back of the mouth; then come the canines (the pointed teeth between the molars and incisors); and then around age 2, the second molars, behind the first set. "Teething molars are often much more painful because they are a big, fat, broad-surfaced tooth," says Dr. Hanna. "Those are the ones where you tend to see bulging gums." In some cases, fluid can build up, creating a bluish cyst over the unerupted molar. When the tooth breaks through and pops the cyst, your baby may wind up with a mouthful of blood, but it looks a lot worse than it is, says Dr. Hanna. "Once the sac erupts and the fluid comes out, it's over. The situation has corrected itself."

Baby teething pain is usually most severe in the days before a tooth cuts through the gums. A child's reaction to teething depends upon many factors, including their tolerance for pain, their personality, and the density of their gum, says Dr. Hanna. That said, most children experience the following signs and symptoms of teething.

Swollen gums. If your child's gums are swollen and you can feel at least one tooth-sized lump, that means teething is in progress.

Chewing, biting, and sucking. Because your child's gums are irritated, you might see them gnawing on just about anything—toys, crib rails, even their clothes and fists.

Rubbing their gums, ears, and cheeks. Your baby might rub their gums to relieve pressure. They might also pull their ears and fidget with their cheeks—especially when their molars appear. (Note that yanking on ears can also signal an ear infection, so it's important to bring up this symptom with your pediatrician.)

Drooling. No one knows why teething babies produce so much saliva, says Dr. Hanna, but the theory is that the increase of muscle movement in the mouth during this teething period simulates chewing, which activates the salivary glands. Excess drool can also cause occasional gagging or coughing.

Mouth rash. The continual wetness from excess drooling can cause a rash around the mouth, chin, or neck.

Irritability and nighttime fussiness. Not surprisingly, teething makes many babies crankier and fussier than usual. "Teething babies may be edgy or hard to settle at naptime and bedtime because of throbbing gums, but it's a dull pain, so you can usually distract them during the day," says Ari Brown, M.D., a pediatrician and coauthor of Baby 411: Clear Answers and Smart Advice for Your Baby's First Year. Note, however, that if your baby is grumpy all day long and appears uninterested in other activities, they might have an ear infection, so it's best to contact your pediatrician.

Decreased appetite. Some kids lose their appetite and refuse to eat or drink. This teething symptom should be short-lived, though.

Low-grade fever. This is characterized by a fever of less than 101 degrees Fahrenheit, taken rectally, and can be caused by gum inflammation. If low-grade fever is accompanied by a runny nose, a bout of diarrhea, or other strange symptoms, call your pediatrician. Jill Lasky, D.D.S., a pediatric dentist at Lasky Pediatric Dental Group in Los Angeles, says teething doesn't cause these symptoms.

Loose stools. Babies may have loose stools from swallowing extra saliva or from changes in diet (teething babies are typically trying various solid foods for the first time). But Dr. Brown says to call the doctor "if the stools are explosive, numerous, or accompanied by blood or mucus."

Until fairly recently, experts widely thought that teething was responsible for practically every cough, sneeze, and cry in a baby's first years. But experts now say that if your baby has worrisome symptoms, it's best to have their pediatrician examine them to rule out something more serious. That's because "the tiny open wounds in the gums that result from the teeth erupting makes it more likely for the baby to catch a little bug," explains Dr. Lasky.

Contact your pediatrician if any of the following symptoms are present:

High fever, diarrhea, or vomiting
The gums are red or blue instead of pink (this usually indicates an eruption cyst, a swelling of the gums above an erupting tooth; although most cysts are benign, it's best to have them checked)
The gums have lesions or bumps
Refusal to eat and drink for more than a couple of hours
Rashes on the body
Your child appears ill

Thanks for your feedback!

During episodes of colic, an otherwise healthy neonate or infant aged 2 weeks to 4 months is difficult to console.

Baby colic, also known as infantile colic, crying for more than three hours a day, for more than three days a week, for three weeks | Parenting Science

Colic is commonly described as a behavioral syndrome in neonates and infants that is characterized by excessive, paroxysmal crying.
Colic is most likely to occur in the evenings, and it occurs without any identifiable cause.
During episodes of colic, an otherwise healthy neonate or infant aged 2 weeks to 4 months is difficult to console.
The most widely used definition of colic was used by Wessel et al; their definition is based on the amount of crying (ie, paroxysms of crying lasting >3 hours, occurring >3 days in any week for 3 weeks).
Colic is a poorly understood phenomenon; it is equally likely to occur in both breastfed and formula-fed infants.

Pathophysiology

The term colic derives from the Greek word kolikos or kolon, suggesting that some disturbance is occurring in the GI tract.

Researchers have also postulated nervous system, behavioral, and psychologic etiologies.
A meta-analysis indicated that colic may be a form of a migraine headache rather than, as has been proposed, a GI condition.
The analysis utilized 3 studies (891 subjects total), one of which indicated that there is a greater likelihood of colic in infants whose mothers have migraine headaches and the other two of which indicated that infants with colic are more likely to experience a migraine in childhood and adolescence.
Using a pooled random-effects model in their analysis, Gelfand and colleagues found the odds ratio for an association between a migraine and colic to be 5.6.
In a secondary analysis, which included two additional studies (both of which also looked at the colic/migraine link but addressed a different primary research question), the odds ratio for the association between a migraine and colic was 3.2.

Statistics and Incidences

Colic is one of the common reasons parents seek the advice of a pediatrician or family practitioner during their child’s first 3 months of life.

Colic affects 10-30% of infants worldwide.
Increased susceptibility to recurrent abdominal pain, allergic disorders, and certain psychological disorders may be seen in some babies with colic in their childhood.
This condition is encountered in male and female infants with equal frequency.
The colic syndrome is commonly observed in neonates and infants aged 2 weeks to 4 months.

Causes

Demonstrated and suggested causes of colic may include the following:

GI causes. GI causes may include but are not limited to gastroesophageal reflux, overfeeding, underfeeding, milk protein allergy, and early introduction of solids.
Inexperienced parents (controversial) or incomplete or no burping after feeding. Incorrect positioning after feeding may contribute to excessive crying; note that colic is not limited to the first-born child, casting doubt on the theory about inexperienced parenting as the etiologic factor.
Exposure to cigarette smoke and its metabolites. Some epidemiologic evidence suggests that exposure to cigarette smoke and its metabolites may be related to colic; maternal smoking and exposure to nicotine replacement therapy (NRT) during pregnancy may be associated with colic.
Food allergy. Some evidence has linked persistent crying in young infants to food allergy; an association between colic and cow’s milk allergy (CMA) has been postulated.
Low birth weight. Data from one study suggested an association between low birth weight and an increased incidence of colic.
Characteristic intestinal microflora. Some reports have focused on intestinal microflora and its association with colic; lower counts of intestinal lactobacilli were observed in infants with colic compared with infants without colic.

Clinical Manifestation

On physical examination, the keys to the diagnosis are as follows:

Normal physical findings. Infants with colic appear normal upon physical examination.
Weight gain. Infants with colic often have accelerated growth; failure to thrive should make one suspicious about the diagnosis of colic.
Exclusion of potentially serious diagnoses that may be causing the crying. On acoustic analysis, colicky crying differs from regular crying; compared with regular crying, colicky crying is more variable in pitch, more turbulent or dysphonic, and has a higher pitch; mothers of infants with colic, unlike mothers of infants without colic, rate the cries as more urgent, discomforting, arousing, aversive, and irritating than usual.

Assessment and Diagnostic Findings

Laboratory studies are usually not indicated in colic unless the physician suspects another condition, such as gastroesophageal reflux.

Clinitest. If the patient’s stools are excessively watery, testing them for excess reducing substances (Clinitest) may be worthwhile; if results are positive, this may be an indication of an underlying GI problem, such as acquired (postinfectious) lactose intolerance.
Stool exam. Stool may be tested for occult blood to rule out cow’s milk allergy (CMA).

Medical Management

Rule out common causes of crying is the first step in treating an infant with persistent crying.

Allow others to care for the infant. Recommend that the parents not exhaust themselves and encourage them to consider leaving their baby with other caretakers for short respites.
Follow-up. Consistent follow-up and a sympathetic physician are the cornerstones of management.
Anticholinergic. Dicyclomine hydrochloride is an anticholinergic drug that has been proven in clinical trials to be effective in the treatment of colic; however, because of serious, although rare, adverse effects (eg, apnea, breathing difficulty, seizures, syncope), its use cannot be recommended.
Diet. Maternal low-allergens diets (ie, low in dairy, soy, egg, peanut, wheat, shellfish) may offer relief from excessive crying in some infants.

Pharmacologic Management

Medications for colic are until under consideration and research.

Simethicone. Simethicone is a nonabsorbable medication that changes the surface tension of gas bubbles, allowing them to coalesce and disperse and releasing the gas for easier expulsion.
Herbal remedies. Herbal remedies have been used in many cultures; the common ingredients include chamomilla, bitter apple, and fenugreek; only a handful of studies of herbal products have been conducted, and additional studies of their safety and efficacy are needed.

Nursing Management

Nursing care of an infant with colic include the following:

Nursing Assessment

Assessment of an infant with colic include:

History. Obtain a detailed history about the timing, the amount of crying, and the family’s daily routine; the benign nature of colic should be emphasized; rule out causes of excessive crying in an infant, such as having hair in the eye, strangulated hernia, otitis, and sepsis.
Physical exam. Perform a physical examination to confirm normalcy; infants with colic often have accelerated growth; weight gain is typical, whereas failure to thrive should make one suspicious about the diagnosis of colic.

Nursing Diagnosis

Based on the assessment data, the major nursing diagnoses are:

Acute pain related to abdominal distention and tenderness.
Deficient knowledge related to lack of exposure and unfamiliarity with information resources.
Impaired parenting related to lack of knowledge and confidence in parenting skills.

Nursing Care Planning and Goals

The major nursing care planning goals for patients with colic are:

Caregiver/s describe/s satisfactory pain control at a level less than 3 to 4 on a rating scale of 0 to 10.
Caregiver/s report improved well-being such as baseline levels for pulse, BP, respirations, and relaxed muscle tone or body posture.
Caregiver/s explains disease state, recognizes the need for medications and understands treatments.
Caregiver/s report improved confidence in parenting and caring for the infant.

Nursing Interventions

Nursing interventions for a child with colic include the following:

Reduce/relieve pain. Assess pain characteristics; acknowledge reports of pain immediately; provide rest periods to promote relief, sleep, and relaxation; place infant on a position of comfort to reduce pain.
Educate caregivers on the disease. Assess ability to learn or perform desired health-related care; determine priority of learning needs within the overall care plan; observe and note existing misconceptions regarding material to be taught; grant a calm and peaceful environment without interruption; include the caregivers in creating the teaching plan, beginning with establishing objectives and goals for learning at the beginning of the session; provide clear, thorough, and understandable explanations and demonstrations; allow repetition of the information or skill.
Improve parenting skills. Interview parents, noting their perception of situational and individual concerns; educate parents regarding child growth and development, addressing parental perceptions; involve parents in activities with the infant that they can accomplish successfully; recognize and provide positive feedback for nurturing and protective parenting behaviors.

Evaluation

Goals are met as evidenced by:

Caregiver/s described satisfactory pain control at a level less than 3 to 4 on a rating scale of 0 to 10 (face scale).
Caregiver/s reported improved well-being such as baseline levels for pulse, BP, respirations, and relaxed muscle tone or body posture.
Caregiver/s explained disease state, recognizes the need for medications and understands treatments.
Caregiver/s reported improved confidence in parenting and caring for the infant.

Documentation Guidelines

Documentation in a patient with colic include:

Individual findings, including factors affecting, interactions, nature of social exchanges, specifics of individual behavior.
Intake and output.
Cultural and religious beliefs, and expectations.
Plan of care.
Teaching plan.
Responses to interventions, teaching, and actions performed.
Attainment or progress toward the desired outcome.

Practice Quiz: Colic

Here’s a 5-item quiz for Colic study guide. Please visit our nursing test bank page for more NCLEX practice questions.

1. Which of the following behaviors would indicate that a client was bonding with her baby?

A. The client feeds the baby every three hours.
B. The client asks the nurse to recommend a good childcare manual. C. The client talks to the baby and picks him up when he cries.

D. The client asks her husband to give the baby a bottle of water.

1. Answer: C. The client talks to the baby and picks him up when he cries.

Option C: This is a good sign that the client is ready and confident about caring for the infant.
Options A, B, D: These options show little confidence in the caregiver, which decreases bonding.

2. A nurse at the family clinic receives a call from the mother of a 5-month old infant. the mother states that the infant is diagnosed with colic at the last check up. Unfortunately, the symptoms have remained the same. Which instructions are appropriate? Select all that apply.

A. Position the infant on his back after feedings. B. Soothe the child by humming and rocking. C. Immediately bring the infant to the emergency department. D. Burp the infant adequately after feedings. E. Provide small but frequent feedings to the infants.

F. Offer the pacifier if it is not time for the infant to eat.

2. Answers: B, D, E, F.

Options B & F: Rocking, riding in a car, humming, and offering a pacifier may comfort the infant.
Options D & E: Decreasing gas formations by frequently burping, giving smaller feedings more frequently, and positioning the infant in an upright seat is also an appropriate teaching.

3. The nurse is assessing a newborn who had undergone vaginal delivery. Which of the following findings is least likely to be observed in a normal newborn?

A. Heart rate is 80 bpm B. Uneven head shape C. Respirations are irregular, abdominal, 30-60 bpm

D. (+) Moro reflex

3. Answer: A. Heart rate is 80 bpm.

Option A: Normal heart rate of the newborn is 120 to 160 bpm.
Options B, C, D: Options A, B, and C are normal assessment findings (uneven head shape is molding).

4. In caring for a young child with pain, which assessment tool is the most useful?

A. McGill-Melzack pain questionnaire B. Simple description pain intensity scale C. 0-10 numeric pain scale

D. Faces pain-rating scale

4. Answer: D. Faces pain-rating scale.

Option D: The Faces pain rating scale (depicting smiling, neutral, frowning, crying, etc.) is appropriate for young children who may have difficulty describing pain or understanding the correlation of pain to numerical or verbal descriptors.
Options A, B, C: The other tools require abstract reasoning abilities to make analogies and use of advanced vocabulary.

5. Which statement represents the best rationale for using noninvasive and non-pharmacologic pain-control measures in conjunction with other measures?

A. These measures potentiate the effects of analgesics. B. These measures are more effective than analgesics. C. These measures block transmission of type C fiber impulses.

D. These measures decrease input to large fibers.

5. Answer: A. These measures potentiate the effects of analgesics.

Option A: Noninvasive measures may result in release of endogenous molecular neuropeptides with analgesics properties. They potentiate the effect of analgesics.
Option B: No evidence indicates that noninvasive and nonpharmacologic measures are more effective than analgesics in relieving pain.
Option C: There is no connection between type C fiber impulses and noninvasive and nonpharmacologic pain-control measures.
Option D: Decreased input over large fibers allows more pain impulses to reach the central nervous system.