Q: I was surprised when I went to the pharmacy to get Baby Anbesol for my granddaughter and found that it is no longer made. I used this product with all my children when they were teething. Why is there no longer anything available to numb their gums?
The medicinal ingredient in products that were previously marketed as pain relievers for teething babies such as Baby Anbesol and Baby Orajel was benzocaine. It is a topical anesthetic used in many over-the-counter products to temporarily numb affected areas to help relieve the pain and discomfort associated with minor skin irritations.
In 2018, Health Canada stopped authorizing the use of products containing benzocaine in children under the age of two. This was due to an increased risk in this age group for a rare but serious medical condition called methemoglobinemia (MetHb).
Methemoglobinemia can occur when benzocaine gets absorbed into the bloodstream. It causes a decrease in the amount of oxygen that red blood cells can deliver throughout the body. Symptoms include weakness, confusion, headache, shortness of breath, fast heart rate and pale, gray or bluish-coloured skin, lips or nailbeds. Methemoglobinemia is a medical emergency as severe cases have resulted in death.
There are reports of this medical condition happening with all strengths of benzocaine-containing products used for teething pain. In some reports, it happened after the first use and in others, it happened after several uses, therefore there is no amount of benzocaine in a product that can be safely used in children under the age of two.
In 2020, Health Canada issued a stop-sales order for any products containing benzocaine that had not updated their package labelling. As you saw at the pharmacy when looking for Baby Anbesol, all the benzocaine-containing products are for at least 2 years of age or older and none claim teething pain as one of their uses. The labels also contain a warning about the symptoms of methemoglobinemia and state children under the age of 12 should be supervised by an adult for two hours after use.
Health Canada has also published safety warnings for the use of teething necklaces in children under the age of three. Teething necklaces such as amber necklaces have resulted in strangulation by getting tightly twisted on the neck and by getting caught up on objects. Necklaces have also broken, and children have choked on the small pieces.
Current recommendations to help ease discomfort from sore or tender gums include things that apply light pressure to the gums. You can use a clean finger to gently rub or massage the area of the gums for two minutes where the tooth is coming in. Babies may not like this at first, but most will come to find it quite soothing.
You can also offer a teething ring made of firm rubber for them to chew on. Fluid-filled rings are no longer recommended due to the risk of babies chewing through the plastic and accidentally ingesting the liquid inside. Teething rings can be cooled in the refrigerator to provide some extra pain relief but should not be frozen. If the ring is too hard, it can cause damage to their sensitive gums and result in more pain after use. Wet facecloths can be cooled in the freezer and then given to a baby to chew on but do not let them freeze solid.
Pain relievers such as acetaminophen and ibuprofen can also be used when the above recommendations have not provided relief. It is important to follow the weight-based dosing on the packaging label, not the age-based dosing, to ensure you give the proper dose for their size. If they are taking other medications, or have medical conditions or allergies, check with your pharmacist to see if these medications are safe to use.
Children under the age of 18 should never be given pain relievers containing acetylsalicyclic acid also known as ASA or Aspirin due to the risk of Reye’s Syndrome, a rare but serious condition that causes swelling in the liver and brain.
The effectiveness of the non-benzocaine-containing products available to rub on a baby’s gums is limited. Due to the amount of drool in their mouths, these products are quickly washed out and may present safety concerns when swallowed as some contain alcohol and plant products that are not meant to be swallowed.
Erin Thompson (BSc, BScPharm) is a graduate of Dalhousie University and a community pharmacist practicing at Shoppers Drug Mart in Quispamsis N.B. Her opinions expressed in this column are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment.