Hmm, what could have happened in the early 90s to explain the significant decrease in incidence of acute hepatitis B? Urkel?
For those of you new to Science-Based Medicine, I am a pediatric hospitalist and spend the majority of my time caring for newborns. It’s an extremely rewarding experience on most days. The babies are usually healthy, the parents are usually happy and appreciative, and I get to give a lot of good news. I also get to dispel a lot of myths and misconceptions regarding the care of infants, which as you can probably imagine, I take great pleasure in.
Parents ask a lot of questions, which I appreciate and encourage, but they also make a lot of claims about the care of children based on their prior experience, advice from well-meaning friends and family, or their evaluation of the online “literature.” Some of these claims I will challenge, nicely of course, when they are demonstrably wrong or increase the risk for a bad outcome. (“We read that babies should sleep inverted like a bat in order to increase blood flow to the brain.”) Some of these claims I acknowledge as an acceptable approach, even if I don’t agree with them myself, if there is low risk or a lack of available quality evidence to guide me. (“We burped our last baby every five minutes during feeds to prevent colic.”) Sometimes I even learn a thing or two from parents.
As a pediatrician I have an opportunity to observe a wide variety of unusual and sometimes alarming parental efforts meant to help children through illness or keep them well. I have recently noticed one particular intervention that seems to be becoming more prevalent, at least in my practice. I’ve begun to see more and more infants sporting Baltic amber teething necklaces. These consist of multiple small beads of amber on a string that is worn around a baby’s neck, and are supposed to relieve the discomfort of teething. Before I had any idea what these necklaces were for or how they were supposed to work, my first reaction was to inform these parents of the dangers of necklaces or anything placed around an infant’s or young child’s neck. Strangulation is a known cause of accidental injury and death in children, and pediatricians are trained to discuss this as part of the routine anticipatory guidance we give to parents. In addition, we strongly advise against giving infants or young children any small items that could be accidentally aspirated, such as the beads found in a necklace of this sort. But I was equally surprised to learn that these necklaces are not intended for babies to chew or gum. Instead, they are supposed to ease a baby’s teething discomfort simply by lying against the skin.
I will not discuss teething here, or the many myths that surround it; that was well covered in a previous post. I will reiterate that there is little-to-no evidence that the majority of concerns parents have about teething are actually due to teething, including fever and diarrhea. The irritability associated with teething also tends to wax and wane for only several days before and after the emergence of a tooth. But let’s assume for the moment that these necklaces actually work to ease the discomfort of teething, and whatever other problems parents tend to associate with the long period of time during which infants and young children develop their teeth. Assuming these necklaces work as recounted in the glowing testimonials on countless websites and parent blogs, how do they produce their dramatic results?