|Year : 2018 | Volume
| Issue : 4 | Page : 291-295
Teething myths among health workers in a tertiary health facility
Ibrahim Aliyu1, Igoche David Peter2, Shakur Abubakar2, Mustafa O Asani1, Godpower C Michael3, Abdulazeez O Ahmed4, Ismail Mohammed Inuwa5, Nasir Ishaq6, Suleiman Dada Aliyu2
1 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2 Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
4 Department of Ear, Nose and Throat, Aminu Kano Teaching Hospital, Kano, Nigeria
5 Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria
6 Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||2-Aug-2018|
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Kano State
Source of Support: None, Conflict of Interest: None
Background: The teething process is part of normal development of the skeletal system; however, different tribes and ethnic groups seem to have a list of symptoms they believe are linked to teething. Could it be that health professionals also hold to these false believes concerning teething? This is important to find out because when systemic problem is misdiagnosed as teething and nothing is done, it may result in death. This study aims to assess the level of knowledge of infants' teething and associated myths among health professionals, to ascertain the attitude of health professionals toward teething in infants, and to identify practices by health professional toward “teething problems.” Materials and Methods: This study was cross-sectional study, conducted from August to September 2016, and multistage sampling method was adopted. Results: Four hundred and fifty health workers participated in the study; however, 427 of them correctly completed the questionnaire giving a response rate of 94.9%. There were 213 (49.9%) males and 214 (50.1%) females with m:f ratio of 1:1. Most respondents (322; 77.8%) believed teething was associated with significant systemic symptoms, 92 (21.5%) did not associate teething with any significant systemic complaint, while only 3 (0.7%) of them were not sure if teething causes systemic illness. Fever and loss of appetite were the most common symptoms associated with teething followed by stooling while skin rash was the least common complaint associated with teething. Conclusion: Teething myths are still prevalent among health-care workers; common illnesses attributed to teething included fever, loss of appetite, excessive salivation, and diarrhea.
Keywords: Systemic illness, teething myths, tertiary health workers
|How to cite this article:|
Aliyu I, Peter ID, Abubakar S, Asani MO, Michael GC, Ahmed AO, Inuwa IM, Ishaq N, Aliyu SD. Teething myths among health workers in a tertiary health facility. Med J DY Patil Vidyapeeth 2018;11:291-5
|How to cite this URL:|
Aliyu I, Peter ID, Abubakar S, Asani MO, Michael GC, Ahmed AO, Inuwa IM, Ishaq N, Aliyu SD. Teething myths among health workers in a tertiary health facility. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2020 Jun 4];11:291-5. Available from: http://www.mjdrdypv.org/text.asp?2018/11/4/291/238166
| Introduction|| |
The teething process is part of normal development of the skeletal system; however, different tribes and ethnic groups seem to have a list of symptoms they believe are linked to teething, and hence, parents receive much advice about this teething which is ill defined, and not evidence based. Teething is essentially an innocuous process; however, severe systemic illnesses have erroneously been associated with it. Mild symptoms formerly thought to be associated with teething were found to be temporally associated, and no symptom cluster reliably predicts the imminent emergence of a tooth. At approximately 6 months of age, when the primary teeth are about to erupt, maternal antibodies on which young children depend begins to decrease while they build up their own antibodies which are not yet sufficient to defend them against infections. Furthermore, child starts to crawl at this age, can pick and place unclean objects in their mouths (oral sensory phase of development). This can introduce pathogens and may lead to gastrointestinal disturbances and associated increase in body temperature. Lack of awareness is thought to be the issue behind the widespread misconceptions around teething. These misconceptions are actually traps for our unsuspecting infants who are administered all kinds of teething remedies including the much talked about “My Pikin” teething mixture. This has led to so much mortality as the former Director General of NAFDAC, Dora Akunyili reported that 25 children had died in Zaria, Ibadan, and Lagos after being administered the drug. This is just a fraction of mortalities associated with teething as a result of ignorance because those infants that die from severe dehydration following acute diarrheal disease diagnosed as “teething” and hence not presented for medical care is not been accounted for.
Adimorah et al. in Enugu found that 90% of mothers think that babies can experience medical problems as a result of teething; fever (71.7%), loose stools (58.3%), and vomiting (35%). Forty percent of the mothers consistently apply teething medications with “teething powder” being the most common medication used – 46.9%. In Ibadan, Ige and Olubukola  found that 64.8% of mothers made a diagnosis of “teething” for febrile illnesses, “cough and catarrh,” and diarrhea affecting their children.
Could it be that all health professionals hold to these dangerous beliefs concerning teething? This is important to find out because when a systemic problem is diagnosed as “the usual teething” and hence nothing is done about to address the ongoing pathology, mortality becomes inevitable. To the best of our knowledge, no study has been done that encompass the entire cadre of health professionals in a tertiary center in Nigeria. It is therefore the interest of this study to find what health professionals know, believe, and practise about teething in infants in a tertiary setting. This study therefore seeks to assess the knowledge, attitude, and practice of health professionals toward teething which hope to determine the level of knowledge of infants' teething and associated myths among health professionals; the attitude of health professionals toward teething in infants; and also to identify practices by health professional toward “teething problems.”
| Materials and Methods|| |
This study was a cross-sectional descriptive study; it was conducted at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria, from August to September 2016. Health workers in AKTH include doctors, nurses, laboratory scientist, pharmacists, and other health workers (such as community health extension workers [CHEWs]). The sample size was determined using the Fisher's formula  and a prevalence of 60% as reported by Denloye et al.; a sample size of 368.8 was obtained which will be approximated to 450 to ensure adequate representation of all categories of respondents. A multistage sampling technique was used in the selection of respondents for this study. There are 931 health workers in 17 clinical departments in AKTH which include Pediatrics, Internal medicine, Community medicine, Psychiatry, Family medicine, Dentistry and Maxillofacial Surgery, Obstetrics and Gynaecology, Surgery, Ear Nose and Throat, Ophthalmology, Anesthesiology/Intensive care, Pathology, Chemical Pathology/Immunology, Hematology, Radiology, Pharmacy, and Physiotherapy. In the first stage, using simple random sampling, 50% of the departments were selected while in the second stage, convenience sampling method was adopted to select the respondents from the selected departments which was based on proportionate distribution of their population in the selected departments.
This study was questionnaire based which was pretested and self-administered. The following information was contained in the questionnaire; category of health worker, years of experience, knowledge about teething and myths around it, and teething remedies ever recommended or used.
The information from respondents was analyzed using Statistical Package for Social Sciences version 16 (SPSS Inc., Chicago Illinois, USA). The mean and standard deviation summarized quantitative variables while qualitative variables such as distribution of the respondents recruited for the study, common complaints reportedly associated with teething by the respondents, sources of information as reported by the respondents, and common remedies often prescribed/advised by the respondents were summarized using frequencies and percentages and categorical variables – such as comparing the profession of the respondents with their perception of teething symptoms; comparing pediatricians and nonpediatricians (among the doctors subgroup); and number of children with perception of teething symptoms – were tested using Fisher's exact tests of significance, while P < 0.05 was considered as statistically significant.
| Results|| |
Four hundred and fifty health workers participated in this study; however, 427 of them completed the questionnaire giving a response rate of 94.9%. There were 213 (49.9%) males and 214 (50.1%) females with male to female ratio of 1:1.
The age ranges and their frequencies were <25 years (25, 5.9%), 25–40 years (333, 78%), and >40 years (69, 16.2%).
Nurses (39.3%) were the most common among the respondents while pharmacists (2.3%) were the least [Table 1].
Most respondents (322; 77.8%) believed teething is associated with significant systemic symptoms, 92 (21.5%) did not associate teething with any significant systemic complaint while only 3 (0.7%) of them were not sure if teething causes systemic illness.
Fever and loss of appetite were the most common symptoms associated with teething followed by stooling while skin rash was the least common complaint associated with teething [Table 2].
|Table 2: Common complaints reportedly associated with teething by the respondents|
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Parents were the most common source of information on teething (44.7%) while school (18.5%) was the third most common source of information; however, the media (1.9%) was the least source of information [Table 3].
However, 323 (75.6%) of the respondents reported willingness to seek for medical care for complaints attributed to teething, while 104 (24.4%) will not seek for medical consultation due to teething complaints.
Three hundred (70.3%) of the respondents will use or recommend teething remedies, while 127 (29.7%) will not use/recommend the use of teething remedies; antibiotics (28.3%) was the most common remedy recommended followed by teething powder while teething soap (0.7%) was the least recommended [Table 4]. Among those who will use or recommend teething remedies, 192 (64%) believed that teething remedies are effective, 63 (21%) think otherwise, while 45 (15%) are not sure of their efficacy.
Thirty-seven (8.7%) of the respondents believed teething complaints may result in the death of a child; while 390 (91.3%) disagree.
Majority of the laboratory scientist (94.7%) associated teething with systemic symptoms while the doctors (60.5%) were the least group associating teething with systemic symptoms [Table 5].
|Table 5: Comparing the profession of the respondents with their perception of teething symptoms|
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Majority of the nonpediatricians believed that teething is associated with systemic symptoms; however, this observation was not statistically significant (#Fisher's exact test = 3.596, P= 0.150); furthermore, most of the respondents (249) who had child/children associated teething with systemic symptoms. Majority of the respondents with children believed teething caused significant systemic symptoms; however, the number of children by the respondents had no significant relationship with their perception of symptoms associated with teething (Fisher's exact test = 2.000, P= 0.364) [Table 6].
|Table 6: Comparing pediatricians and nonpediatricians and number of children with perception of teething symptoms|
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| Discussion|| |
Teething and the myths surrounding it still remain a debate with varied responses in different fora. Our study cut across all health workers with different perceptions on teething. Our study showed that overall, 77.8% of our respondents believed teething was associated with significant systemic complaint. This finding was higher than the 48% reported by Ispas et al. in New Zealand; it is worrisome that 60.5% of doctors in this study believed that teething was associated with significant systemic complaints, which was higher than the 42.4% earlier report by Aliyu et al. This may be the effect of highly subspecialized practice; therefore, doctors limit their interest to their field. However, 80%–94.7% of pharmacist, clinical assistants, CHEWs, nurses, ward attendant, and laboratory scientists believed teething was associated with significant systemic complaint. This observation was similar to previous reports.,,, Among these, laboratory scientists (94.7%) mostly associated teething with systemic complaints in our study; this may be attributed to their limited patient contact. The curriculum content among the various health specialties may account for the disparity in knowledge. Therefore, their knowledge on teething may be limited to their personal experiences. Parents of the respondents were the most common source of information on teething; this observation was similar to previous studies among nursing mothers  and nurses  but differed from that of Aliyu et al. who reported medical school as the most common source of information on teething in their study among medical doctors. There is a strong family tie among Africans and cultures – including myths – are often passed from one generation to another. In some tribes, parents and grandparents often have strong hold on our decisions; including health-related matters., This pattern is disturbing; health workers should be better informed on health-related issues and the best place to achieve this should be from the medical schools and clinical practices. Therefore, this observation shows the failure of our school curriculum, our poor reading culture, and inadequacy of continuous medical education programs.
Fever and loss of appetite were the most common complaints associated with teething; this observation was similar to that reported by Aliyu et al., Ibrahim et al., and Baykan et al.; similarly, Bankole et al. in Ibadan reported in a survey that 82.1%, 61.4%, and 27.9% of nurses implicated fever, diarrhea, and boils, respectively, as signs of teething; furthermore, Denloye et al. reported that 60% of community health officers believed that children have systemic problems during teething periods with fever and diarrhea being the most frequent symptoms associated with teething. However, 75.6% of the respondents in this study were willing to refer caregivers appropriately for the supposed teething complaints; this finding was similar to previous reports., This observation is encouraging because it provides the opportunity for doctors to rightly inform caregivers on the process of teething.
Antibiotics was the most common remedy recommended for teething in this study; this was in variance with that of Aliyu et al. who reported more of teething syrup usage among nursing mothers; however, Ibrahim et al. observed more prescription of teething powder among nurses; while Bankole et al. reported more prescription of analgesics for teething among nurses.
The practices of prescribing teething remedies were prevalent in this study; this observation was similar to previous reports.,, However, this was seen mostly among the nonpediatric group. Furthermore, 64% of the respondents believed in the effectiveness of these remedies, and this observation was similar to previous reports.,,, Hence, limited knowledge on teething development may account for this misperception. Therefore, continuous medical education program will mitigate this erroneous belief.
Although most respondents who were caregivers believed teething was associated with systemic complaints, this observation was not statistically significant; furthermore this finding was similar to earlier report which showed lack of statistical significance of the number of children of caregivers on their health-seeking behavior on teething-related illnesses.
Majority of the respondents disagreed that teething complaints could result in child death; this observation was similar to earlier reports.,,
| Conclusion|| |
Teething myths are still prevalent among health-care workers; common illnesses attributed to teething in this study include fever, loss of appetite, excessive salivation, and diarrhea; furthermore, prescriptions of teething remedies which had been associated with complications are still common. This is worrisome considering the role health workers play as health-care providers and advocates.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]