I have never quite accepted the assertion from a parent or colleague that a miserable, unwell child is suffering from 'teething'.

A review in Archives of Diseases in Childhood has examined the evidence for clinical features that are 'markers' for teething. The review aimed to determine features that could help doctors readily identify teething as the cause of symptoms and exclude other, potentially more serious, conditions.

The review identified three prospective and two retrospective studies that investigated the link between teething and systemic symptoms. These studies, covering 2,590 children, were analysed.

Biting, drooling, gum rubbing, irritability, sucking and temperature >37.5°C were all associated with teething, but there were no consistent symptoms and nowhere near any statistical certainty.

Another retrospective study was also reviewed, which studied 50 children admitted to hospital with a presenting complaint of 'teething' (but who were, presumably, fairly unwell). Disturbingly, 48 of these children were subsequently found to have a medical diagnosis, including one case of bacterial meningitis.

Some sensible suggestions are made by the review, such as looking in a child's mouth to deal with the parent's concerns, but the bottom line is a recommendation to discount teething as a cause of illness in any young child and instead to seek and treat other organic causes.

Tighe M, Roe MFE. Does a teething child need serious illness excluding? Arch Dis Child 2007;92:266-268