Baby Teething Gels: Benzocaine Safety Warning
# Baby Teething Gels: Benzocaine Safety Warning — What Every Parent Must Know
Quick Answer
**Do not use benzocaine teething gels on babies or children under 2 years old.** The U.S. Food and Drug Administration (FDA) issued a black-box warning in 2018 against all over-the-counter benzocaine oral products for infants and young children because they can cause a rare but life-threatening blood condition called **methemoglobinemia**. Benzocaine teething gels, sold under brand names like Orajel, Anbesol, and Hurricaine, can reduce the blood’s ability to carry oxygen, leading to pale or bluish skin, breathing difficulties, seizures, and even death. The American Academy of Pediatrics (AAP) strongly supports this warning and recommends that parents avoid all topical teething medications containing benzocaine. Safe alternatives include a chilled (not frozen) teething ring, gently massaging your baby’s gums with a clean finger, and, for significant pain, acetaminophen or ibuprofen approved by your pediatrician. If your child has accidentally received a benzocaine product and shows pale, gray, or blue-colored skin, lips, or nail beds, seek emergency medical care immediately.
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The FDA Warning on Benzocaine Teething Products
In May 2018, the FDA issued one of its most serious drug safety communications: a directive to stop marketing and selling all over-the-counter benzocaine oral products intended for children under 2 years of age. This was not a suggestion or a guideline. It was a formal, enforceable warning backed by decades of adverse event reports and multiple infant deaths linked to benzocaine use.
The [FDA Drug Safety Communication](https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-risks-benzocaine-and-serious-blood-disorder) stated clearly that benzocaine products should no longer be used to treat teething pain in infants or young children. The agency also required manufacturers to add a prominent black-box warning, the most serious warning the FDA can mandate, to all benzocaine products, including those marketed for adults. The warning highlights the risk of methemoglobinemia and instructs consumers to use the product only as directed and to avoid use in children under 2.
Why did it take until 2018 for this warning? The concern had been building for years. Reports of methemoglobinemia in infants exposed to benzocaine had been appearing in medical literature and FDA adverse-event databases for more than a decade. In 2006, the FDA had already required a warning on the prescription benzocaine product Cetacaine. By 2011, the FDA had received 21 additional reports of methemoglobinemia linked to benzocaine oral products. But the over-the-counter teething gels remained on pharmacy shelves, marketed directly to parents desperate for relief for their teething babies. It took sustained pressure from pediatricians, consumer advocacy groups, and families who had been harmed before the agency acted on the over-the-counter products in 2018.
The FDA’s action went further than many parents realize. The agency did not just warn against benzocaine. In a parallel action, the FDA also warned against homeopathic teething tablets, products like those made by Hyland’s, which were found to contain inconsistent amounts of belladonna, a toxic substance. This dual warning means that essentially all topical teething medications marketed for babies carry unacceptable risks. Parents searching for a quick, easy gel to rub on their baby’s sore gums should understand that the medical consensus is clear: no topical anesthetic product has been shown safe and effective for infant teething pain.
The [American Academy of Pediatrics](https://www.healthychildren.org) echoed the FDA’s position, reinforcing that benzocaine should never be used for teething and advising parents to use only non-medicated comfort measures. The AAP’s stance matters because it represents the unified voice of 67,000 pediatric specialists in the United States, the doctors who care for babies every single day. When both the FDA and the AAP speak in unison about a safety issue, parents should listen.
Despite the 2018 warning, benzocaine teething products have not entirely disappeared from the marketplace. Some parents may still have old tubes of Orajel Baby or Anbesol infant gel in their medicine cabinets, purchased before the warning. Others may receive well-meaning but outdated advice from relatives who used these products with older children. Check the labels of any teething product in your home and dispose of any containing benzocaine. If you are unsure, check the active ingredients: **benzocaine** should never appear on any product you use on a baby or toddler.
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What Is Methemoglobinemia?
Methemoglobinemia is a blood disorder in which the amount of methemoglobin in the blood rises to dangerous levels. To understand why this is dangerous, it helps to understand how normal blood carries oxygen.
Your red blood cells contain hemoglobin, a protein that binds to oxygen in your lungs and delivers it to every organ and tissue in your body. Hemoglobin contains iron in a specific chemical state, ferrous iron (Fe²⁺), that allows it to grab oxygen molecules and release them where they are needed.
Benzocaine disrupts this process by chemically altering the iron inside hemoglobin. It oxidizes the ferrous iron (Fe²⁺) into ferric iron (Fe³⁺), converting hemoglobin into **methemoglobin**. Methemoglobin cannot carry oxygen. As methemoglobin levels rise, the body’s oxygen supply falls, and tissues begin to suffocate even though the baby is breathing normally.
In healthy individuals, the body naturally maintains methemoglobin levels below about 1% of total hemoglobin. An enzyme system called NADH-methemoglobin reductase continuously converts methemoglobin back to functional hemoglobin, keeping the system in balance. However, infants, especially those under 6 months, have immature enzyme systems. Their NADH-methemoglobin reductase activity is significantly lower than that of adults, meaning they cannot clear methemoglobin from their blood efficiently. This developmental vulnerability is precisely why benzocaine is so dangerous for babies.
When methemoglobin levels rise above 10-15%, visible symptoms begin to appear. The skin, lips, and nail beds may take on a pale, gray, or bluish color, a condition called cyanosis. This cyanosis does not respond to supplemental oxygen the way normal cyanosis does, which is a key diagnostic clue. At levels above 30-40%, symptoms become severe: rapid heart rate, fatigue, headache, dizziness, and confusion. At levels above 50-60%, seizures, coma, and death can occur. In fatal cases of benzocaine-induced methemoglobinemia in infants, methemoglobin levels have been reported as high as 60-70%.
The progression can be fast. Methemoglobinemia from benzocaine can develop within minutes to a few hours after application. Parents may apply a teething gel to their baby’s gums and then notice, an hour later, that their child looks pale, is breathing rapidly, and seems unusually sleepy or irritable. Because the condition can deteriorate quickly, it is a medical emergency that requires immediate treatment with methylene blue, a medication administered intravenously that converts ferric iron back to ferrous iron and restores hemoglobin function.
Methemoglobinemia is not dose-dependent in a predictable way. Even small amounts of benzocaine, far less than what is recommended on the product label, can trigger severe methemoglobinemia in a vulnerable infant. Some babies may have undiagnosed genetic conditions that make them even more susceptible, such as glucose-6-phosphate dehydrogenase (G6PD) deficiency or hereditary methemoglobinemia. You cannot know in advance whether your baby has one of these predispositions, which is why the only safe approach is to avoid benzocaine entirely.
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Why Teething Gels Are Unsafe for Babies
The danger of benzocaine teething gels is not limited to methemoglobinemia. There are several additional reasons these products are unsafe for infant teething pain.
Benzocaine numbs the entire mouth. When you rub a teething gel on your baby’s gums, the numbing effect does not stay localized. It spreads to the tongue, the cheeks, the back of the throat, and the palate. This widespread numbing can interfere with the gag reflex and the baby’s ability to swallow safely. In very young infants, whose swallowing coordination is still developing, this can increase the risk of aspiration, inhaling saliva, milk, or food into the lungs. Several case reports have described infants who experienced feeding difficulties or aspiration events after benzocaine gel application.
The numbing effect is also temporary and does not address the underlying cause of teething pain. Teething pain comes from inflamed, swollen gum tissue being stretched by an erupting tooth. Benzocaine only masks the symptom. It does nothing to reduce inflammation or speed the eruption process. The numbing effect typically lasts only 15-20 minutes, creating a cycle where parents reapply the product repeatedly, increasing the baby’s total benzocaine exposure and the risk of methemoglobinemia with each application.
Many parents apply the product incorrectly. Teething gels are often applied right before bedtime, in the hope of helping the baby sleep through the night. But applying a numbing gel while the baby is lying down and may not be fully conscious increases the risk of the product pooling in the back of the throat. This is particularly dangerous because the gel may be swallowed, exposing the baby to a larger dose and potentially numbing the throat tissues that protect the airway. Some parents also use more gel than recommended, believing that more will provide better relief. In the case of benzocaine, more means a greater risk of methemoglobinemia.
The products have also been marketed in ways that mislead parents. Before the FDA’s 2018 warning, teething gels were sold in packaging that prominently featured babies, often with soothing imagery and claims of fast relief. The words “baby” and “infant” on the label gave parents a false sense of safety. Surely a product marketed for babies would be safe for babies? The FDA’s subsequent crackdown on labeling was necessary precisely because the marketing had created a dangerous disconnect between the product’s risk profile and the consumer’s perception of safety. Even after the warning, some products may still be found on shelves with old labeling, so parents must read the active ingredient list carefully rather than relying on the product name or marketing imagery.
Finally, benzocaine products are not FDA-approved for teething pain. No benzocaine oral product has ever been evaluated by the FDA in clinical trials specifically for infant teething pain relief. The products were marketed under older regulatory pathways that did not require the same rigorous safety and efficacy evidence as newer drug applications. Benzocaine teething gels were never proven safe or effective for babies. They were simply assumed to be safe because they had been on the market for decades. The methemoglobinemia risk proved that assumption tragically wrong.
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Symptoms of Methemoglobinemia — Act Immediately
Every parent should know the signs of benzocaine-induced methemoglobinemia. Because the condition can develop rapidly and become life-threatening, recognizing the symptoms early and acting fast can save your child’s life.
The hallmark symptom is **cyanosis**, a pale, gray, or blue discoloration of the skin, lips, and nail beds that does not improve with oxygen. This is the most visible and most commonly reported sign. In lighter-skinned babies, the lips may appear an alarming slate-blue or ash-gray. In darker-skinned babies, check the inside of the lips, the nail beds, and the mucous membranes of the mouth, which may appear gray or lavender.
Other symptoms to watch for include:
– **Rapid or labored breathing.** The baby may breathe faster than normal or appear to be working harder to breathe, with the chest pulling in with each breath (retractions).
– **Fatigue or unusual sleepiness.** The baby may become lethargic, difficult to wake, or less responsive than usual. This is a sign that the brain is not receiving adequate oxygen.
– **Irritability or fussiness.** Paradoxically, some babies become extremely irritable or inconsolable, which may be a sign of distress from low oxygen levels.
– **Rapid heart rate.** The heart beats faster to try to compensate for the reduced oxygen-carrying capacity of the blood.
– **Headache or dizziness.** Older toddlers may be able to express that their head feels funny or that they feel dizzy.
– **Confusion or altered mental status.** In severe cases, the baby or toddler may appear confused, disoriented, or difficult to engage.
– **Seizures.** A late and very serious sign of severe methemoglobinemia.
– **Loss of consciousness.** The most critical emergency sign.
**If your baby or toddler has been exposed to a benzocaine product and shows ANY of these symptoms, call 911 or go to the nearest emergency department immediately.** Do not wait to see if symptoms improve on their own. Do not call your pediatrician’s office first and wait for a callback. This is a true emergency that requires immediate treatment with methylene blue in a hospital setting.
When you arrive at the emergency department, tell the medical team that your child was exposed to benzocaine and how much and when. This information will help them make a rapid diagnosis. Methemoglobinemia can be confirmed with a simple blood test (co-oximetry) that measures the methemoglobin level directly. Treatment with intravenous methylene blue is highly effective when administered promptly, and most children recover fully if treated in time. Delayed treatment, however, can result in permanent neurological damage or death.
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Safe Teething Pain Relief Alternatives
While benzocaine and other topical anesthetic gels are off the table, there are several safe and effective ways to soothe a teething baby. The key message, and the reassuring one for worried parents, is that teething is a normal developmental process that does not require medication in most cases. Simple, non-medicated comfort measures are usually sufficient.
A solid or liquid-filled teething ring that has been cooled in the refrigerator (not the freezer) provides gentle, localized cold therapy that helps reduce gum inflammation and numbs the area naturally. The pressure of chewing on the ring also counteracts the pressure from the erupting tooth, which is instinctively why teething babies want to bite and chew on everything. Choose a teething ring that is free of BPA, phthalates, and PVC, and inspect it regularly for signs of wear or damage that could create a choking hazard. Never tie a teething ring around a baby’s neck. This is a strangulation risk.
Wash your hands thoroughly, then use your index finger to gently rub and massage your baby’s sore gums. The pressure can be very soothing and helps relieve the discomfort of an erupting tooth. Some parents find that dipping the finger in cool water first adds a pleasant temperature element. This method has zero chemical risk, costs nothing, and can be done as often as your baby needs it.
A clean, damp washcloth that has been twisted and chilled in the refrigerator makes an excellent teething tool. Your baby can chew on it safely, and the texture provides additional sensory stimulation. Make sure the washcloth is not frozen solid, as extreme cold can damage delicate gum tissue. Always supervise your baby during use to prevent the cloth from unraveling and becoming a choking hazard.
If your baby has started solid foods and your pediatrician has approved the introduction of finger foods, you can offer a large piece of chilled cucumber, a thick strip of cold banana, or a teething biscuit designed for infants. These should only be offered when your baby is seated upright and closely supervised. Avoid any food that could break off into small, hard pieces that could cause choking.
For babies who are in significant pain, particularly when teething pain is interfering with sleep or feeding, your pediatrician may recommend acetaminophen or ibuprofen. These are oral medications that work systemically to reduce pain and inflammation, and they have well-established safety profiles when used at the correct dose for the baby’s weight. **Never give your baby aspirin**, as it has been linked to Reye’s syndrome, a rare but serious condition. Always consult your pediatrician before giving any medication, and use the dosing syringe provided with the product rather than a kitchen spoon. Ibuprofen is generally not recommended for babies under 6 months old.
Sometimes the most powerful medicine is simply holding your baby close, offering extra nursing or bottle feeds, and providing the emotional comfort of your presence. Teething can be a frustrating and painful process for babies, and they need their parents’ reassurance. Skin-to-skin contact, gentle rocking, and a calm environment can all help a teething baby feel more secure and relaxed.
The AAP’s [teething guidance](https://www.healthychildren.org/English/ages-stages/baby/teething-tooth-care/Pages/Teething-Pain-Relief.aspx) emphasizes that teething pain should be managed without medication whenever possible and that the safest approaches are physical comfort measures like those listed above. When medication is needed, acetaminophen or ibuprofen are the recommended options, not topical anesthetics.
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What to Avoid — Beyond Benzocaine
Benzocaine is not the only ingredient that poses risks in teething products. Parents should also avoid the following:
**Lidocaine.** Lidocaine is another local anesthetic sometimes found in teething gels and liquids. The FDA has warned against using lidocaine 2% viscous solution (a prescription product sometimes used off-label for teething pain) in infants and children because it can cause serious harm, including heart problems, seizures, and breathing difficulties, if applied too frequently or in too large an amount. Like benzocaine, lidocaine numbs the throat and can interfere with the gag reflex.
**Homeopathic teething tablets and gels.** As mentioned earlier, the FDA has warned against homeopathic teething products after laboratory testing revealed that some contained elevated and inconsistent levels of belladonna, a toxic plant alkaloid. Belladonna can cause seizures, breathing difficulties, excessive sleepiness, muscle weakness, skin flushing, constipation, difficulty urinating, agitation, and other serious symptoms in babies. In 2016, the FDA investigated 400 adverse event reports, including 10 infant deaths, associated with homeopathic teething products. These products have been recalled, but parents should remain vigilant.
**Alcohol-containing teething remedies.** Some older or imported teething preparations contain alcohol, which should never be given to an infant or young child. Even small amounts of alcohol can be toxic to babies.
**Amber teething necklaces.** Amber teething necklaces have become popular in some parenting communities, but they are not only ineffective. They are dangerous. These necklaces pose a serious strangulation and choking hazard. The AAP and the FDA have both warned against their use. There is no scientific evidence that amber teething necklaces relieve teething pain, and the risk of injury far outweighs any theoretical benefit.
**”Natural” or herbal teething products.** The word “natural” on a product label does not mean safe. Many herbal teething products contain ingredients that have not been tested for safety in infants. Some may contain benzocaine or other anesthetics under different names. Always read the full ingredient list and consult your pediatrician before using any product marketed as natural or herbal.
**Aspirin.** Never give aspirin to a baby or child. Aspirin use in children has been linked to Reye’s syndrome, a rare but potentially fatal condition that causes swelling in the liver and brain.
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When to Call Your Pediatrician
While teething is a normal part of development and does not typically require medical intervention, there are situations in which you should contact your pediatrician:
– **Your baby has a fever above 100.4°F (38°C).** Teething may cause a slight elevation in temperature, but it does not cause high fever. If your baby has a fever, something else may be going on, a cold, an ear infection, or another illness, and your pediatrician should evaluate them.
– **Your baby refuses to eat or drink.** It is normal for teething babies to be fussier with feeding, but if your baby is refusing feeds entirely or showing signs of dehydration (fewer wet diapers, dry mouth, no tears when crying), call your doctor.
– **Your baby is inconsolable.** Some fussiness and irritability during teething is normal. If your baby is crying non-stop and cannot be soothed by any comfort measures, or if the pain seems far more severe than what you would expect from teething, your pediatrician should be consulted to rule out other causes of pain such as an ear infection, an erupting molar, or an oral ulcer.
– **You have accidentally applied a benzocaine product to your baby.** Even if your baby seems fine, call your pediatrician or Poison Control (1-800-222-1222 in the United States) immediately for guidance. The symptoms of methemoglobinemia can be delayed, and it is better to get professional advice than to wait and watch.
– **You notice any signs of methemoglobinemia** (pale, blue, or gray skin/lips/nail beds, rapid breathing, extreme sleepiness, irritability). As stated earlier, this is a medical emergency. Go to the emergency department or call 911.
– **You are unsure whether a product is safe.** If you have a teething product and you are not sure whether it contains benzocaine, lidocaine, or other unsafe ingredients, take it to your pharmacist or send the label to your pediatrician for review. When in doubt, do not use it.
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Frequently Asked Questions
Q: Is Orajel Baby safe for teething?
A: No. Orajel Baby products that contain benzocaine should never be used on infants or children under 2. Some Orajel Baby formulations may now be benzocaine-free, but you must read the active ingredient list on every product. If you see benzocaine listed, do not use it on your baby.
Q: Can I use Anbesol for my baby’s teething pain?
A: No. Anbesol contains benzocaine and should not be used in children under 2 for the same reasons discussed above. The FDA’s warning applies to all over-the-counter benzocaine oral products, including Anbesol.
Q: Are there any safe teething gels for babies?
A: Currently, no topical anesthetic gel is safe for infant teething. The safest options are non-medicated comfort measures such as a chilled teething ring, a clean finger gum massage, or a chilled washcloth. For significant pain, consult your pediatrician about using acetaminophen or ibuprofen.
Q: What about teething gels marketed as “natural” or “herbal”?
A: Be very cautious. Some natural and herbal teething products have been found to contain belladonna, benzocaine, or other ingredients that are unsafe for babies. The FDA has issued warnings about homeopathic teething tablets containing belladonna. Always read the full ingredient list and consult your pediatrician before using any product on your baby.
Q: My mother used benzocaine gel on me when I was a baby. Why is it considered unsafe now?
A: The risk of methemoglobinemia from benzocaine was not widely recognized for many years. It was only after decades of use, during which adverse events accumulated in the FDA’s databases, that the full scope of the danger became clear. Medical knowledge evolves over time, and products that were once considered safe are sometimes found to carry unacceptable risks. The FDA’s 2018 warning was the culmination of this growing body of evidence. This is not a case of parents doing something wrong in the past. It is a case of science catching up and protecting future children.
Q: Can benzocaine teething gels be used on children over 2 years old?
A: The FDA’s 2018 warning specifically targeted children under 2. Benzocaine products carry a black-box warning for all users, including older children and adults, due to the risk of methemoglobinemia. However, the risk is highest in young children. For older children, benzocaine products may still be used for other indications (such as canker sores or sore throat) under medical guidance, but they are not appropriate for teething in any age group when safer alternatives exist.
Q: How long does teething pain last?
A: Teething pain is typically intermittent and comes in waves. Most babies experience the most discomfort in the days immediately before and during the eruption of a tooth. The first teeth (usually the lower central incisors) tend to erupt around 6-10 months, and the process continues until around age 2-3 years when all 20 primary teeth have come in. Some teeth cause more discomfort than others. Molars, which are larger and have a broader surface, tend to be more painful than incisors.
Q: Does teething cause diarrhea, vomiting, or high fever?
A: No. Teething may cause mild symptoms such as drooling, gum swelling, mild irritability, and a slight temperature elevation (below 100.4°F / 38°C). High fever, diarrhea, vomiting, and other significant symptoms are not caused by teething and should be evaluated by your pediatrician as they may indicate an illness or infection.
Q: What should I do if I already used benzocaine gel on my baby?
A: If your baby received benzocaine and is now showing any symptoms, pale/blue skin, rapid breathing, unusual sleepiness, or irritability, seek emergency medical care immediately. If your baby seems completely normal but you are concerned, call your pediatrician or Poison Control (1-800-222-1222) for guidance. It is always better to be cautious, as methemoglobinemia can develop hours after exposure.
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Summary
The message from the FDA, the AAP, and pediatricians worldwide is unequivocal: **benzocaine teething gels are dangerous and should never be used on babies or young children.** The risk of methemoglobinemia, a potentially fatal blood condition that starves the body’s tissues of oxygen, is real, well-documented, and not worth taking for a product that provides only brief, superficial pain relief.
Parents have safe, effective, and chemical-free ways to comfort their teething babies. A chilled teething ring, a clean finger massage, extra cuddles, and, when necessary, pediatrician-approved acetaminophen or ibuprofen can manage teething discomfort without putting your child’s life at risk. Read product labels carefully, avoid any product containing benzocaine or lidocaine, and consult your pediatrician if you have any questions or concerns.
Teething is a temporary phase. Your baby will get through it, and you can help them do so safely.
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*Written by Dr. Martinez, MD (Pediatrics) | Medically approved by Dr. Ahmed Raza, MD (Pediatrics) | Updated for 2026*
*This article is for informational purposes only and does not constitute medical advice. Always consult your pediatrician with questions about your child’s health.*
*Sources: U.S. Food and Drug Administration (FDA), American Academy of Pediatrics (AAP) / HealthyChildren.org*
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Written by Dr. Sophia Martinez, MD (Pediatrics), MD (Pediatrics) | Medically reviewed by Dr. Ahmad Raza, MD (Pediatrics) | Updated for 2026
This article is for general informational purposes only and does not constitute medical advice. Always consult your pediatrician with questions about your child’s specific health needs.
