|Year : 2015 | Volume
| Issue : 1 | Page : 8-12
Teething: Beliefs and behaviors of mothers attending well baby clinics in Benin City, Nigeria
Vincent Y Adam1, Blessing I Abhulimhen-Iyoha2
1 Department of Community, University of Benin Teaching Hospital, Benin City, Nigeria
2 Department of Child Health, University of Benin Teaching Hospital, Benin City, Nigeria
|Date of Web Publication||17-Mar-2015|
Vincent Y Adam
Department of Community Health, University of Benin Teaching Hospital, Benin City
Source of Support: None, Conflict of Interest: None
Background: Teething is an important developmental milestone in young children. Mothers attribute several symptoms to teething and their beliefs in turn affect their behavior towards the healthcare of children during the period of tooth eruption. This study assessed maternal beliefs and behaviors towards teething in young children in Benin City, Nigeria. Methods: A descriptive cross-sectional study was carried out among mothers who brought their babies to Well Baby Clinics in three health facilities in Benin City, Nigeria. The tool for data collection was a structured researcher-administered questionnaire. Data were analyzed using SPSS version 16.0. Results: Mothers of 420 children (mean age 16.2 ± 8.6 months) participated in the study. Over two-third 302 (71.7%) believed that infant teething is associated with various symptoms. The commonest symptoms reported were fever 258 (85.7%) and diarrhea 241 (80.0%) while the least was redness of the gums, 2 (0.7%). A greater proportion of respondents, 224 (74.4%), 186 (61.8%) and 184 (61.1%) managed teething discomfort with teething syrups, tepid sponging and teething toys respectively. More than half of the respondents 263 (54.3%) and 162 (56.3%) gave analgesics to relieve fever and oral rehydration solution (ORS) for diarrhea attributed to the teething process respectively. Conclusion: Mothers' beliefs encourage the use of "teething" as a ready explanation for childhood diseases. They utilize analgesics, ORS, teething syrup and herbal medications to relieve perceived teething symptoms. The misconception about teething can be corrected through health education of mothers when they access health facilities. The mass media may also be employed to reach a larger audience.
Keywords: Teething, Maternal behaviors
|How to cite this article:|
Adam VY, Abhulimhen-Iyoha BI. Teething: Beliefs and behaviors of mothers attending well baby clinics in Benin City, Nigeria. Afr J Med Health Sci 2015;14:8-12
|How to cite this URL:|
Adam VY, Abhulimhen-Iyoha BI. Teething: Beliefs and behaviors of mothers attending well baby clinics in Benin City, Nigeria. Afr J Med Health Sci [serial online] 2015 [cited 2020 Sep 25];14:8-12. Available from: http://www.ajmhs.org/text.asp?2015/14/1/8/153377
| Introduction|| |
Teething is an important developmental milestone in young children attracting the attention of parents, physicians, and dentists. A number of local and systemic symptoms have been attributed to teething in children, which include irritability, drooling, mouthing, sleep disturbances, fever, diarrhea, and susceptibility to infections. ,,, Many customs and superstitions linger on among people in all socioeconomic classes, educational levels, age groups, and ethnic backgrounds believing that teething causes ailments.  Over the centuries various treatments have been used frequently depending on the tenets of the medical profession and lay people. Some professionals recommend medication for "teething."  Some academic publications tend to take the view that teething causes few, if any, symptoms. ,
During the teething period of an infant's life, passive immunity due to maternal antibodies wanes and exposure to a wide variety of childhood illnesses occurs.  Maternal false beliefs associated with teething may interfere with the prompt diagnosis and management of a range of serious illnesses.  Will these beliefs alter, now that we know how innocuous teething is? , Strong parental beliefs which are not borne out of evidence are unlikely to change unless they are evaluated and attempts are made to correct them. It is hoped that the findings from this study will help form the basis for health promotional messages aimed at addressing misconception about teething in our study locale.
| Materials and Methods|| |
This descriptive cross-sectional study was conducted between July 2011 and October 2012 among mothers of healthy children attending the Well Baby clinics of the University of Benin Teaching Hospital (UBTH), Central Hospital and Stella Obasanjo Women and Children's Hospital (SOWCH) which are the three major public healthcare facilities (HCFs) in Benin City, Nigeria.  UBTH with a bed complement of 700 is a tertiary HCF located in Egor Local Government Area (LGA), while Central Hospital and SOWCH with bed compliment of 500 and 300 are secondary HCFs located in Oredo and Ikpoba-Okha LGAs respectively. ,
The calculated sample size with allowance for 10% nonresponse of 383 was derived from the Taylor formula,  N = pq/(E χ 1.96)  used for descriptive studies where P = 65.5% (proportion of mothers who believed that teething should be accompanied with systemic signs and symptoms in a study in Ile Ife, Nigeria),  q = 100 −65.5 and E = 5% (error margin). A total of 420 participants were utilized for the study. From each of the selected HCFs, 140 respondents were selected. Any mother with a child aged 6-30 months, with at least one tooth in the mouth erupted, or erupting was purposively selected.
The tool for data collection was a structured, interviewer-administered questionnaire. A questionnaire was used to collect qualitative information on the child's age, gender, birth order, mothers' level of education, occupation, beliefs about teething and behavior toward perceived teething problems in their children. Occupation was classified according to the International Standard Classification of Occupation.  Ethical approval was obtained from the Research and Ethics Committee of UBTH and permission was obtained from the management of the three HCFs while verbal informed consent was obtained from each participant.
Data analysis was done using the Statistical Package for Scientific Solutions (SPSS) version 16 (SPSS Inc. 233 South Wacker Drive, 11 th Floor, Chicago, IL) and computer Program for Epidemiologist: PEPI version 4.0 (Sagebrush Press, Salk Lake city).  Mean, standard deviation and ranges were used as appropriate to describe continuous variables. Fisher's exact test was utilized to test for association between variables with the level of significance set at P < 0.05.
| Results|| |
A total of 420 respondents were studied. The mean age of the children was 16.2 ± 8.6 months with almost half of the children 199 (47.4%) in the age group 6-12 months. More than a third 143 (34.1%) and 157 (37.3%) were in the first and second birth orders respectively. Over half of the mothers 233 (55.5%) had secondary level of education and about two-fifth 159 (44.0%) were in skill level 1 occupational classification [Table 1].
Over two-third 301 (71.7%) of the mothers believed that teething was associated with various symptoms. The most common symptoms reported were fever 258 (85.7%) and diarrhea 241 (80.0%) while the least was redness of the gums 2 (0.7%). More than half of the mothers, 175 (58.0%) believed that the symptoms were due to teething because friends and relatives told them so. The health facility and patent medicine stores were places of treatment of symptoms associated with teething in 188 (62.5%) and 107 (35.5%) respondents, respectively [Table 2].
|Table 2: Mothers' perceived discomfort associated with teething and place of treatment|
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The major remedies administered to relieve teething symptoms were teething syrups 224 (74.4%), tepid sponging 186 (61.8%), teething toys 184 (61.1%) and analgesics 149 (49.5%). All 258 respondents reported using paracetamol to treat fever while over a tenth used herbal medicines 35 (13.6%). Oral rehydration solution was used for the treatment of diarrhea by about two-thirds 162 (67.2%) of the mothers [Table 3].
|Table 3: Remedies and interventions administered to relieve teething discomfort|
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Most mothers despite their level of education attributed to teething, the symptoms seen in their children during the teething period. However, there was a statistical significant difference between the level of education and maternal beliefs about teething symptoms (P = 0.0004) [Table 4].
Use of teething syrups to relieve symptoms associated with teething increased with the level of education of mothers except at the tertiary level. The difference was statistically significant (P < 0.0001) [Table 5].
|Table 5: Mothers' level of education and use of teething syrups to relieve teething discomfort|
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| Discussion|| |
The study revealed that most mothers in Benin City, Nigeria believed that teething is associated with various symptoms such as fever, diarrhea, restlessness, loss of appetite, gingival swelling and lots more. This is in consonance with several other studies in other parts of Nigeria ,,, and other nations like India, ,, Brazil, , Columbia,  Israel  and USA.  Many parents ascribe numerous infant symptoms to teething despite little evidence to support such an attribution. While some authors consider "teething diarrhea" as a myth, several others from various geographical locations, as alluded to above, have documented the popular belief in the association of frequent loose stools with eruption of the teeth. During the period of deciduous tooth eruption, other changes in the infant's immune system, growth and development are also occurring. At this time, passive immunity due to maternal antibodies wanes and predisposes the infant to a wide range of childhood infections like respiratory tract infections, middle ear infections, urinary tract infections;  which may present with fever and irritability alongside other features. Maternal false beliefs associated with teething may interfere with the prompt diagnosis and management of a variety of serious illnesses.  Strong maternal beliefs which are not evidence-based are likely to linger except they are documented and adequate attempts are made to correct them. Whether these beliefs about teething symptoms such as diarrhea are facts or myths, one fact clearly remains that infections like diarrheal diseases contribute immensely to under-five mortality in the developing world  and this calls for attention from health care professionals, parents/caregivers and other stakeholders.
The mothers in Benin City use medicines such as analgesics (paracetamol), teething syrups, oral rehydration salt and even herbal remedies to relieve the supposed teething symptoms of their young children; a finding similar to reports of several studies done locally and internationally. ,,, Though symptoms like fever and diarrhea were attributed to teething by the mothers in this study, the use of antipyretics and ORS for home management of fever and diarrhea is commendable, since they are key household life-saving interventions that could lead to reduction in child mortality. However, the use of herbal remedies such as "Dokhan" and "Haifa" in Sudan,  which involve use of smoke and lancing of the alveolar process with heated needle could worsen the morbidity burden of the children, hence should be discouraged. In consonance with current study, a study in Australia  done in 2010 documented that majority (76.1% and 65.6%) of the parents utilized systemic and topical analgesics including use of interventions such as allowing their children to bite on chilled objects, in handling perceived teething symptoms. Symptoms associated with teething should be examined, and appropriate management instituted in order to prevent further morbidity and mortality in children.
The current study revealed a statistically significant relationship between maternal level of education and their beliefs about teething symptoms contrary to findings of Uti et al.
Many of the conditions historically thought to result from teething are now accurately diagnosed as specific clinical entities  and the many symptoms claimed by mothers to be as a result of tooth eruption can be explained by pathological etiologies other than the normal teething process. These mothers attribute fever (which may be due to infections) and diarrhea as physiologically accompanying tooth eruption and so expect them to pass without any fatalities. They would likely, therefore, not give attention to a potentially dangerous condition such as childhood diarrheal diseases, an attitude that may be detrimental to child survival. Some publications have attempted to clarify some of the disputed features of teething to be that the localized symptoms of teething vary between individuals and severe systemic signs and symptoms are unrelated to teething , and if present, the infant should be promptly referred to a physician for an accurate diagnosis and appropriate treatment. The treatment of an ailment (teething problem) that apparently does not exist, or at most associated with minor and relatively infrequent symptoms , led to untold mortality in children who were managed with the poisonous "my pikin baby teething mixture" in Nigeria.  Such avoidable deaths can be prevented if mothers are correctly informed. For example, Plutzer et al. demonstrated that providing mothers with information on how to address perceived teething symptoms markedly reduced the use of medications for symptom relief.
| Conclusion|| |
Mothers' beliefs about teething in infancy irrespective of educational attainment encourage the use of "teething" as a ready explanation for childhood diseases. This may underplay the need for prompt medical treatment in cases of childhood fevers and diarrheal diseases. Educating parents, caregivers and the general public will help correct these false beliefs attributed to teething and foster prompt health-seeking behavior. This role of health education falls on health professionals and educators. We recommend that the content of health education given to mothers during antenatal clinic as well as well baby clinic visits should include evidence-based information on infant teething. Mothers should also be informed about appropriate measures to take when mild symptoms are noticed as well as recognition of danger signs and symptoms of common childhood illnesses, which would necessitate presentation at a health facility. This implies that the health workers need to furnish themselves with facts on the process and period of tooth eruption in childhood with which to educate the populace. To reach a larger audience, the mass media (both electronic and print) can also be used to disseminate evidence-based information on teething in infants.
| Acknowledgment|| |
We acknowledge Ejokirhie S and Emeagui P of the School of Medicine, University of Benin who assisted in data collection and the mothers recruited for this study for their cooperation.
| References|| |
Oziegbe EO, Folayan MO, Adekoya-Sofowora CA, Esan TA, Owotade FJ. Teething problems and parental beliefs in Nigeria. J Contemp Dent Pract 2009;10:75-82.
Feldens CA, Faraco IM, Ottoni AB, Feldens EG, Vítolo MR. Teething symptoms in the first year of life and associated factors: A cohort study. J Clin Pediatr Dent 2010;34:201-6.
Kiran K, Swati T, Kamala BK, Jaiswal D. Prevalence of systemic and local disturbances in infants during primary teeth eruption: A clinical study. Eur J Paediatr Dent 2011;12:249-52.
Wake M, Hesketh K, Lucas J. Teething and tooth eruption in infants: A cohort study. Pediatrics 2000;106:1374-9.
Ashley MP. It′s only teething...a report of the myths and modern approaches to teething. Br Dent J 2001;191:4-8.
Oziegbe EO, Esan TA, Adekoya-Sofowora CA, Folayan MO. A survey of teething beliefs and related practices among child healthcare workers in Ile-Ife, Nigeria. Oral Health Prev Dent 2011;9:107-13.
Ramos-Jorge J, Pordeus IA, Ramos-Jorge ML, Paiva SM. Prospective longitudinal study of signs and symptoms associated with primary tooth eruption. Pediatrics 2011;128:471-6.
McIntyre GT, McIntyre GM. Teething troubles? Br Dent J 2002;192:251-5.
Kakatkar G, Nagarajappa R, Bhat N, Prasad V, Sharda A, Asawa K. Parental beliefs about children′s teething in Udaipur, India: A preliminary study. Braz Oral Res 2012;26:151-7.
Sood S, Sood M. Teething: Myths and facts. J Clin Pediatr Dent 2010;35:9-13.
Macknin ML, Piedmonte M, Jacobs J, Skibinski C. Symptoms associated with infant teething: A prospective study. Pediatrics 2000;105:747-52.
Edo State Government. Edo State Health Development Plan (2010-2015). Benin City: Edo State Ministry of Health; 2010. p. 1-139.
University of Benin Teaching Hospital. Patient Information Handbook. Benin City: University of Benin Press; 2005. p. 6-7.
Taylor DW. The calculation of sample size and power in the planning of experiments. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada 1994; 1-23.
International Labour Organization. International Standard Classification of Occupation (ISCO-08). Geneva: International Labour Office; 2012. p. 1-433.
Gahlinger PM, Abramson JH. Programme for Epidemiological Calculations, Version 4.0; 1993-2001.
Ige OO, Olubukola PB. Teething myths among nursing mothers in a Nigerian community. Niger Med J 2013;54:107-10.
Adimorah GN, Ubesie AC, Chinawa JM. Mothers′ beliefs about infant teething in Enugu, South-east Nigeria: A cross sectional study. BMC Res Notes 2011;4:228.
Uti OG, Savage KO, Ekanem EE. Maternal beliefs about infant teething. J Community Med Prim Health Care 2005;17:61-4.
Noor-Mohammed R, Basha S. Teething disturbances; prevalence of objective manifestations in children under age 4 months to 36 months. Med Oral Patol Oral Cir Bucal 2012;17:e491-4.
Mota-Costa R, Medeiros-Júnior A, Aciolly-Júnior H, Araújo-Souza GC, Clara-Costa Ido C. Mothers′ perception of dental eruption syndrome and its clinical manifestation during childhood. Rev Salud Publica (Bogota) 2010;12:82-92.
Peretz B, Ram D, Hermida L, Otero MM. Systemic manifestations during eruption of primary teeth in infants. J Dent Child (Chic) 2003;70:170-3.
Sarrell EM, Horev Z, Cohen Z, Cohen HA. Parents′ and medical personnel′s beliefs about infant teething. Patient Educ Couns 2005;57:122-5.
Barlow BS, Kanellis MJ, Slayton RL. Tooth eruption symptoms: A survey of parents and health professionals. ASDC J Dent Child 2002;69:148-50, 123.
Abhulimhen-Iyoha BI, Okolo AA. Morbidity and mortality of childhood illnesses at the Emergency Paediatric Unit of the University of Benin Teaching Hospital, Benin City. Niger J Paediatr 2012;39:71-4.
Ene-Obong HN, Iroegbu CU, Uwaegbute AC. Perceived causes and management of diarrhoea in young children by market women in Enugu State, Nigeria. J Health Popul Nutr 2000;18:97-102.
Awadkamil M. Mothers′ misconception and traditional practices towards infant teething symptoms in Khartoum. IOSR J Pharm 2012;2:448-51.
Owais AI, Zawaideh F, Bataineh O. Challenging parents′ myths regarding their children′s teething. Int J Dent Hyg 2010;8:28-34.
Plutzer K, Spencer AJ, Keirse MJ. How first-time mothers perceive and deal with teething symptoms: A randomized controlled trial. Child Care Health Dev 2012;38:292-9.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]