Teething can be extremely uncomfortable for children, but there’s little evidence that cutting primary teeth is any more painful for babies born with orofacial clefts. The one thing that seems to hold true is that teething is an extremely individual process, whether or not a child was born with a cleft.

Do Teeth Come Earlier In Babies With Orofacial Clefts?

Teething usually begins between 2 and 12 months after birth, according to What To Expect, although some children won’t start teething until later than that. This timeline seems to hold for children with cleft lip and palate, too, but again, every baby is different.

Teething In Babies With Orofacial Clefts Infographic
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Some parents have reported teeth coming in much slower on the side of a child’s cleft, though this experience is far from consistent. We’ve also seen anecdotes in which parents say that clefts can speed up the emergence of baby teeth.

Do Babies With Clefts Experience More Teething Pain?

While clefts can have a significant effect on the way a child’s teeth develop, from missing teeth or extra teeth to irregularly-positioned teeth, the teething process itself isn’t very different.

Just like kids without clefts, some babies with a cleft gum or palate will teeth without any sign of discomfort. Others will cry, drool and chew for months. It all depends on your child.

Signs That Your Baby Is Teething

The symptoms of teething vary widely:

  • flushed cheeks
  • dribbling and drooling (along with skin rashes caused by all that drool)
  • gnawing and chewing (everything)
  • agitation and irritability
  • trouble sleeping
  • swollen gums
  • rejecting food
  • grabbing ears (since gums, ears and cheeks share a common set of nerves)

The most common symptom is probably chewing. During teething, many babies will try to gnaw on just about anything they can get their hands on. Biting down on something provides counter-pressure that momentarily cancels out the pressure caused by an emerging tooth. Most common, however, doesn’t mean universal.

Deb Lonzer, a pediatrician at Cleveland Clinic, says that no one symptom is experienced by more than a third of babies. That can make explaining the cause of a child’s discomfort very difficult. Lonzer, who spoke with BabyCenter in 2014, says that experiencing multiple symptoms at the same time increases the likelihood that teething is to blame, but there’s only one way to know for sure. It also happens to be pretty obvious: the appearance of a tooth. If you or your child’s doctor can’t see a tooth emerging from the gum, it’s hard to know whether or not your child’s discomfort is actually being caused by teething.

Safe Remedies For Teething

Watching a child suffer through teething can be painful. Many parents swear by homeopathic remedies, like Hyland’s Teething Tablets and Gels. While some say that these products can ease an infant’s symptoms, recent warnings from the US Food & Drug Adminsitration will likely give parents pause.

According to the FDA, homeopathic teething products, which contain a poisonous plant called belladonna, have been linked to severe side effects in children. Seizures have been reported, as have difficulty breathing, lethargy and weakness, all symptoms consistent with belladonna poisoning. Tragically, ten deaths have been linked to these homeopathic products, the New York Times reports, and the FDA is telling parents to stop using them immediately. Although the link between homeopathic teething products and harmful side effects in babies hasn’t yet been confirmed, the agency is currently investigating the issue.

Here are three remedies for teething pain that we know are safe:

  1. Gum massage – your baby chews on stuff while teething to counteract the pressure exerted by an emerging tooth. You can provide this counter-pressure yourself. All you need is a clean finger and gentle massage.
  2. Chilled objects – chilling a spoon in the fridge is another option. Just apply the cold, but not frozen, spoon’s rounded side to your baby’s gums. Some parents like to rinse a washcloth in cold water for their child to gnaw on.
  3. Teething toys – many companies sell plush toys that are safe for kids to chew.
  4. Teething necklaces – made from the same materials as some teething toys, a teething necklace gives your child an object to gum while you’re holding her. Make sure the necklace is from an FDA-approved silicone, one free of BPA, latex, lead or any other substances that can be harmful.
  5. Over-the-counter pain relievers – if you feel comfortable giving your child medications, infant acetaminophen or ibuprofen can relieve pain. Be sure to check with your pediatrician first, since pain relievers might not be appropriate for some children.

Until recently, parents often used gels with benzocaine, a local anesthetic, to numb a teething child’s gums. Medications that contain benzocaine, like Anbesol and Orajel, are not advised for use in babies. Benzocaine can cause a rare condition called methemoglobinemia, which reduces the amount of oxygen in the bloodstream and can be fatal. The FDA now recommends that parents attempt medication-free methods for teething, before contacting their doctors if those techniques don’t work.

Can Babies Be Born With Teeth?

Yes, and it’s more common among infants with orofacial clefts.

Estimates suggest that between 1 in 2,000 and 1 in 3,000 babies are born with at least one “natal” tooth, although they usually occur in pairs. In a recent review of studies on the subject, researchers at the University of Calgary found natal teeth are almost always mandibular central incisors – the two bottom teeth right in the front of a child’s mouth. These are usually the first primary teeth to emerge as a baby begins teething.

As many parents have learned, natal teeth are much more common in babies born with cleft lip and palate than they are in the general population. While estimates on this topic vary as well, up to 10% of infants born with bilateral cleft lip and palate will have natal teeth, according to a 1996 study published in the Cleft Palate-Craniofacial Journal. Around 2% of babies with unilateral cleft lip and palate will be born with exposed teeth.