title: Early-life factors affect risk of pain and fever in infants during teething periods.
abstract: OBJECTIVE
  This longitudinal study aimed to investigate the prevalence of teething-related pain and fever and the early-life factors that may affect the risk of experiencing these disturbances within the first 1.5 years of life.
  
  
  METHODS
  Participants were recruited (n = 1033) through the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort (n = 1237). Interviews were performed tri-monthly regarding the prevalence of teething pain and fever in children from 6 to 18 months of age. Crude and multivariable analyses were conducted using Poisson-log regression models.
  
  
  RESULTS
  Prevalence rates for teething pain and fever were 35.5 and 49.9 % respectively. Multivariable Poisson regression analysis showed maternal second-hand tobacco smoke (SHS) exposure to increase the risk of both pain (mean ratio = 1.35; p = 0.006) and fever (mean ratio = 1.22; p = 0.025), whereas SHS exposure plus active smoking further increased risk of teething pain in the children (mean ratio = 1.89; p = 0.029). Delivery via Caesarean section increased risk of teething pain (mean ratio = 1.27; p = 0.033), while prenatal plasma vitamin D insufficiency lowered such a risk (mean ratio = 0.62; p = 0.012). Compared to Chinese infants, Indian babies exhibited lower risk of teething pain and fever (both p ≤ 0.001).
  
  
  CONCLUSIONS
  Early-life factors such as tobacco smoke exposure and vitamin insufficiency during pregnancy, ethnicity and childbirth via Caesarean section may significantly affect the child's susceptibility to teething-related pain and fever.
  
  
  CONCLUSIONS
  Knowledge of prevalence and risk factors of teething disturbances may better equip primary caregivers and healthcare professionals to accurately detect teething-related local and/or systemic signs/symptoms and effectively facilitate tobacco cessation among pregnant women.
authors.affiliation: Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
authors.forename: Carolina
authors.initials: C
authors.lastname: Un Lam
authors.affiliation: Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore, Singapore. denhsus@nus.edu.sg.
authors.forename: Chin-Ying Stephen
authors.initials: CS
authors.lastname: Hsu
authors.affiliation: Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
authors.forename: Robert
authors.initials: R
authors.lastname: Yee
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
authors.forename: David
authors.initials: D
authors.lastname: Koh
authors.affiliation: Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Yung Seng
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore, Singapore.
authors.forename: Mary Foong-Fong
authors.initials: MF
authors.lastname: Chong
authors.affiliation: Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
authors.forename: Meijin
authors.initials: M
authors.lastname: Cai
authors.affiliation: Department of Maternal Fetal Medicine, KK Women's and Children's Hospital (KKH), Singapore, Singapore.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kwek
authors.affiliation: Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
authors.forename: Seang Mei
authors.initials: SM
authors.lastname: Saw
authors.affiliation: Singapore Institute for Clinical Sciences, Agency for Science and Technology Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore, Singapore.
authors.forename: Peter
authors.initials: P
authors.lastname: Gluckman
authors.affiliation: Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Yap Seng
authors.initials: YS
authors.lastname: Chong
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects; D004198:Disease Susceptibility; D005157:Facial Pain / Q000209:etiology*; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects; D014078:Tooth Eruption; D014094:Tooth, Deciduous; D014808:Vitamin D Deficiency / Q000453:epidemiology
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Fever; Infants; Pain; Perinatal; Prenatal; Teething; Tooth eruption