The FDA's Stance: Why Anbesol Is Not Recommended
The U.S. Food and Drug Administration (FDA) has consistently advised parents and caregivers against using topical pain relief products containing benzocaine or lidocaine for infants experiencing teething pain. U.S. versions of Anbesol, including the Maximum Strength liquid, contain 20% benzocaine, a local anesthetic. The FDA has mandated that manufacturers of these products add explicit warnings, prohibiting their use in children under two years old and specifically for teething. This is due to a rare but life-threatening side effect called methemoglobinemia.
The Danger of Methemoglobinemia
Methemoglobinemia is a serious blood disorder where the amount of oxygen carried by red blood cells is significantly reduced. The condition can develop within minutes to hours after applying benzocaine-based products and can be fatal in severe cases. The highest risk is among infants and children under two years old.
Symptoms of methemoglobinemia include:
- Pale, gray, or blue-colored skin, lips, and nail beds
- Shortness of breath
- Fatigue or lack of energy
- Confusion or lightheadedness
- Rapid heart rate
- Headache
If you observe any of these signs in your child after using a benzocaine product, seek immediate medical attention.
The Lack of Efficacy
Beyond the serious safety concerns, topical teething gels and liquids are not very effective for relieving teething pain. The medication mixes with the baby's saliva and is quickly washed away and swallowed, providing little to no lasting numbing effect on the gums. Swallowing the product can increase the risk of systemic absorption of the anesthetic, which contributes to the danger of methemoglobinemia.
A Global Perspective: Benzocaine vs. Lidocaine Formulations
It is important to note that Anbesol formulations can differ by country. While U.S. products often contain benzocaine, some products, such as those sold in the UK, contain lidocaine. The FDA has also issued warnings against using prescription oral viscous lidocaine for teething pain due to the risk of serious side effects, including seizures. Regardless of the specific anesthetic, the U.S. health community's consensus is to avoid these products for infant teething.
Comparison of Anbesol Formulations for Infant Teething
| Feature | Anbesol (U.S. - Benzocaine 20%) | Anbesol (UK - Lidocaine) | Consensus (U.S. Medical) |
|---|---|---|---|
| Active Ingredient | Benzocaine (20%) | Lidocaine Hydrochloride (0.9% or 1.0%) | Neither is recommended |
| Target Age (on label) | Children 2 years and older; label explicitly states "Do not use in children under 2" | Children over 5 months | Use of any topical anesthetic for teething is discouraged. |
| FDA Recommendation | Do not use for teething or in children under 2 due to methemoglobinemia risk. | N/A (U.S. FDA warning covers similar lidocaine products). | Avoid both for teething infants due to severe risks. |
| Key Risks | Methemoglobinemia (life-threatening blood disorder) | Serious side effects including seizures if swallowed or over-applied. | Methemoglobinemia, seizures, or other serious harm. |
Safe and Pediatrician-Recommended Alternatives to Anbesol
Fortunately, there are many safe and effective non-medicated ways to soothe a teething baby, as recommended by the American Academy of Pediatrics (AAP) and other health experts.
- Massage the Gums: With a clean finger, gently rub or massage your baby's gums to provide counter-pressure, which can be very soothing.
- Provide a Cool Teething Ring: A firm rubber teething ring that has been chilled in the refrigerator can help numb the gums. Avoid frozen teething rings, as they can become too hard and potentially damage a baby's gums.
- Use a Cool, Wet Washcloth: A clean washcloth, wet and chilled in the refrigerator, provides a safe and effective chewing surface.
- Offer Distraction and Comfort: Sometimes, a simple hug, a favorite song, or a new toy can distract your baby from the pain. The power of parental comfort should not be underestimated.
- Try Mesh Feeders with Frozen Foods (for older babies): If your baby is old enough for solid foods, a mesh feeder filled with frozen fruit or breastmilk can offer cooling relief.
- Consider Systemic Pain Relief (with a doctor's guidance): If your baby is over six months old and clearly in significant discomfort, a pediatrician may recommend a low, age-appropriate dose of acetaminophen (e.g., Infant Tylenol) or ibuprofen (for babies over 6 months). Never administer any medication without consulting a healthcare professional first.
What to Do If Your Baby Has Used Anbesol
If your baby has been given Anbesol liquid or any other oral anesthetic for teething, it is important to know what to watch for. Be vigilant for the signs of methemoglobinemia listed above. Because these symptoms can mimic other conditions, it is best to err on the side of caution. If you are concerned, contact a doctor or call a Poison Control Center immediately.
Conclusion: Prioritizing Infant Safety Over Quick Fixes
In conclusion, Anbesol liquid, particularly the benzocaine-based versions sold in the U.S., is not safe for babies, especially those under two years old. The serious risk of methemoglobinemia far outweighs any temporary, ineffective relief it might offer for teething pain. Parents and caregivers should heed the FDA's warnings and rely on safer, non-medicated methods recommended by pediatricians, such as gum massage and chilled teething toys. If these simple measures are not enough, a consultation with a healthcare provider is the safest course of action to ensure your infant's well-being. For more information on safely soothing teething pain, consult the FDA's consumer updates on the topic, such as the one found here: Safely Soothing Teething Pain in Infants and Children.
