Teething myths among nursing mothers in North-Western Nigeria
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0975-2870.153139
Background: Teething has over the years been associated with complains of systemic symptoms from parents, and at times are over treated by health-care professionals. This study seeks to determine common teething complaints reported by nursing mothers. Materials and Methods: This study was multicenter involving 224 nursing mothers. It was cross-sectional and questionnaire-based relevant information collected were: The socio demographic characteristics, knowledge of teething and myths associated with teething, and the attitude of nursing mothers toward the use of teething remedies. Results: Two hundred and three (90.62%) of them believed teething caused symptoms; common complaints that were attributed to teething by mothers were diarrhea, vomiting, increased salivation; however, fever was the predominant complaint, and their parents were the most common source of information on teething in 50% of them, while only a mother (0.4%) was informed on the process of teething at the hospital. Furthermore, the number of children did not affect the desire to seek for medical care for teething symptoms. Common remedies used were as follows: 59 (26.3%) nursing mothers used teething syrup, 43 (19.2%) nursing mothers used teething powder, 16 (7.2%) of them used traditional herbs while 8(3.6%) of them used multiple preparations; however 91 (40.6%) of them did not use any remedy. One hundred and seven (47.8%) of the mothers believed that these remedies worked, 67 (29.9%) of them disagreed while 50 (22.3%) were not sure of their efficacy. Conclusion: Parents should be educated on normal expectations of the teething process; and not to undermine the seriousness of illnesses erroneously attributed to teething. Keywords: Myths, Nigerian nursing mothers, teething
Teething is an important developmental skeletal milestone. It is the process of eruption of the deciduous teeth, and the age at first tooth eruption may vary ranging from 6 to 18 months. [1] Different cultures have varied believes associated with teething, some believe it causes fever ("granny's tale"), [1] while in some Nigerian communities, other common complaints related to teething include diarrhea, drooling of saliva, irritability, loss of appetite, poor weight gain, convulsion [2],[3],[4],[5],[6] - however, the source of these information remains a myth. The controversy is further compounded by health professionals, who in an attempt to please parents prescribe unnecessary medications for teething. Some of these so called "teething remedies" may be hazardous to health; a case in point is the "my pikin" dilemma, [7] which resulted in the death of Nigerian children. Furthermore, early scientist like Hippocrates believed teething was associated with itching gum, diarrhea and fever, [1],[8] while others believe it is an innocuous process. [9] These conflicting reports may result in improper parental education, and parents undermining the severity of such systemic symptoms wrongly attributing them to teething; [8] therefore, it is not surprising these myths still persist. This study hopes to determine the perception of teething problems among nursing mothers in North-Western Nigeria, and the source of these myths.
This was a cross-sectional descriptive study conducted between April and July 2014. Nursing mothers were attending the infant immunization clinic of two Federal Medical Centers in Birnin Kudu, Jigawa State and Birnin Kebbi, Kebbi State, in Nigeria, respectively, were included in this study. Mothers who have experienced at least an episode of teething in their children were included. Informed consent was obtained from each of the selected mothers, and those who declined consent were excluded. The participants were assured of confidentiality, and that nonparticipation in the study would not in any way affect the care of their children. The names of the participants were excluded from the questionnaire for reasons of confidentiality. Both Birnin Kudu and Birnin Kebbi shared similar sociodemographic characteristics, the women are predominantly farmers, traders, seamstresses and civil servants, and this formed the basis of their occupational classification. Sample size was determined using statistical formula for descriptive studies; [10] using a prevalence of 75.5% gotten from previous study, [5] sample size of 224 (making provision for non-response) was calculated. A systematic random sampling method was adopted, and the sampling interval was derived by determining the average monthly immunization clinic attendance for each institution; for the study duration of 4 months an estimated attendance of 2,016 nursing mothers was divided by 112 (for each of the institution). Therefore, one in every 18 nursing mother was selected until the required sample size was obtained. Survey instrument Pretested questionnaires were administered by students of the school of nursing and house-officers after been trained on questionnaire administration. The following information were collected: The socio demographic characteristics, knowledge of teething and myths associated with teething, and the attitude of nursing mothers toward use of teething remedies. Data management The data obtained were analyzed using Statistical Package for social Sciences version 16.0 (SPSS, Chicago, Ill, USA). Frequencies of qualitative variables were summarized using tables and percentages were calculated. Chi-square test for judging significance of the qualitative variable was explored with P < 0.05 quoted as been statistical significant.
There were 224 nursing mothers involved in this study; [Table 1] shows that most of the mothers were in the 25-40 years age-group while Hausas were the predominant ethnic group studied.
Symptoms of teething Two hundred and three (90.62%) of the mothers believed teething caused symptoms in their children, 14 (6.25%) did not associate teething with symptoms while 7 (3.13%) of the mothers were not sure if teething caused any symptom. Fever was the predominant complaint witnessed followed by loss of appetite, while the least was a convulsion [Table 2].
Sources of information on teething as observed among nursing mothers One hundred and twelve (50.0%) of the mothers got information on teething from their parents, 35 (15.6%) of them had personal experiences from their children, 23 (10.4%) got it from their grand-parents, 20 (8.9%) got information from friends, 18 (8.0%) got information from school, 9(4.0%) of them got information from multiple sources, 6 (2.7%) of them had no information on teething, while only one (0.4%) of them was informed about teething from the hospital. Mothers seeking medical care Two hundred and eight (92.8%) of the mothers accepted taking their children to hospital for teething symptoms, while 16 (7.2%) of them preferred home treatment. Eighty-eight (42.3%) of those who will take their children to hospital had secondary school leaving certificate qualification while 21 (10.1%), 66 (31.7%) and 33 (15.9%) of them had primary school leaving certificate, no formal education and tertiary qualification respectively. However, of the 16 that will not seek for health-care services, 8 (50.0%), 1 (6.2%) and 7 (43.8%) had no formal education, primary school leaving certificate qualification and secondary school leaving certificate qualification respectively. Furthermore, [Table 3] shows that their number of children had no statistical significant relationship to their health seeking behavior (χ2 = 2.953, df = 2, P = 0.23).
Remedies used One hundred and thirty-three (59.4%) of the nursing mothers used teething remedies, while 91 (40.6%) of them did not use any remedy. The most common remedies used by nursing mothers were teething syrup, followed by teething powder, while the least was teething soap [Table 4]. One hundred and seven (47.8%) of the mothers believed that teething remedies were effective, 67 (29.9%) of them disagreed, while 50 (22.3%) were not sure of their efficacy. Twenty-one (9.4%) of the mothers claimed to have lost at least a child to teething problems while 203 (90.6%) did not report any child loss due to teething problems.
Impact of socioeconomic status on teething perception Although most mothers who had at least secondary school leaving certificate believed that teething was associated with symptoms; there was not statistically significant relationship between teething perceptions and their educational status (χ2 = 7.084, df = 6, P = 0.31, Cramer's V = 0.31); similarly, their occupational status had not statistically significant relationship with their believes on teething symptoms (χ2 = 8.074, df = 8, P = 0.43, Cramer's V = 0.43) [Table 5].
[Table 6] shows that most of the mothers who were unemployed, farmers, traders, civil servants, and seamstress were informed about teething by their respective parents but this was not statistically significant (χ2 = 33.579, df = 28, P = 0.22, Cramer's V = 0.22); similarly, irrespective of the educational status, their parents were the most common source of information on teething, though this was not statistically significant when compared to other sources (χ2 = 29.525, df = 21, P = 0.10, Cramer's V = 0.10).
Teething is a physiological process; however, it has been associated with a lot of erroneous perceptions over the years and at-times resulting in harmful practices to children. Illnesses often attributed to teething by mothers varies in different society however, common examples include fever, diarrhea and vomiting. This study therefore tried to identify common myths associated with teething in two health facilities in Nigeria, and sources of these misconceptions. We have documented that mothers of the 25-40 years old group constituted the predominant age-group in this study, this observation was similar to that observed by Opeodu and Denloye [11] - they are the child-bearing age-group. Some complaints associated with teething are beyond medical explanation, and parents still hold on tenaciously to these believes despite evidences to the contrary. [12],[13] Most of the mothers in this study believed that teething was associated with symptoms (90.62%), which was similar to that reported by Baykan et al., [14] surprisingly, convulsions was reported as been caused by teething; however, fever, loss of appetite, loose stools, and vomiting were the most common complaints documented in this study; this was similar to that documented by Ige and Olubukola [15] but differ from that reported by Baykan et al., [14] which reported fever as the third most common complaint and loose stools was reported by 51.8% of the nursing mothers which was higher than the 28.8% reported by Ene-Obong et al. [16] Time of first tooth eruption often coincides with period of declining maternal protective immunity, [17] coupled with poor personal hygiene and environmental sanitation, incidence of diseases such as malaria and diarrhea may be expected to increase at this period, which are often wrongly attributed to teething by mothers. Most mothers (60.4%) got information on teething from their parents and grand-parents, which was similar to that reported by Smitherman et al., [18] but higher than the 48% documented by Opeodu and Denloye. [11] Only 0.4% and 8.0% of the mothers were informed on teething at the hospital and school respectively. The educational and occupational status of nursing mothers did not significantly influence their perceptions on teething in this study. The extended family system in our setting may have a strong influence in their perception of health related events because parents and grand-parents readily share their personal experiences with their children even if they are wrongly interpreted. This may not be surprising in the northern part of Nigeria because parents/grand-parents are held in high esteem, and seen as role models this is related to their traditional believes, which respect parents especially mothers. Therefore, irrespective of the extent of exposure of nursing mothers to western culture, it may not be uncommon for their parents to make decisions for them on health related matters. This is similar to what was reported in a Malawian study where older women, mothers, and grandmothers were shown to influence outcome of maternal and child health. [19],[20] Therefore, positive engagement of parents, grandmothers and community elders may significantly reduce these misconceptions on teething, and also improve the health indices in Nigeria. Unfortunately, health-care professionals including community health-care workers, who are closer to the community are also involved in the dissemination of wrong information on teething. [21],[22] Despite their believes, 92.8% of mothers agreed to taking their children to hospital with teething complaints; this is better than that reported by Ige and Olubukola. [15] This was a positive feedback in this study because it avails us the opportunity to further enlighten mothers on teething process. Most nursing mothers (59.4%) used teething remedies, and 47.4% of them believed these remedies were effective. The commonest remedy used was teething syrup. However, some mothers used cloth and plastic teething rings for soothing, this should be of concern because these may be a source of transmission of infection causing diarrhea, which will wrongly be attributed to teething. Some of the teething syrups have been proven to contain chemicals such as opiates and antihistamines, which are not recommended in children less than 2 years, [23] and some could be injurious to children; [24],[25] - typical case was the "my pickin" controversy, which led to the death of 84 Nigerian children. [3],[26],[27] Therefore, the 9.4% of those who claimed to have lost children from teething-related illnesses might have been due to complications from some of these medications and other harmful practices rather than the teething process.
Teething myths are common among nursing mothers in North-Western Nigeria, and their family members are common sources of these erroneously perception. Therefore, parents should be educated on normal expectations of teething, and not to undermine serious illnesses such as febrile illnesses and diarrhea disease erroneously attributing them to teething. Health practitioners ought to do more in enlightening parents on teething, and best ways of addressing issues related to it.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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