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Home / Have Any Babies Choke on Amber Teething Necklaces

Have Any Babies Choke on Amber Teething Necklaces

Experts have warned that this popular jewelry is not only ineffective at soothing a child's pain, but is also dangerous. So why does the trend persist?

Credit... Max Loeffler

This story was originally published on July 23, 2019 in NYT Parenting.

The first thing Danielle Morin saw when she arrived to pick up her 18-month-old son, Deacon, from his at-home day care were the fire trucks. "I sent him to day care just like any other day," Morin said. "I did not know the nightmare that was ahead."

When she approached the Fontana, Calif., nursery that day in 2016, the firefighters and day care workers informed her that her son had been found unconscious and was rushed to the hospital. As Morin made her way to the emergency room, she learned that while Deacon was napping, he'd been strangled by a string of smooth, golden-brown beads he'd been wearing around his neck to relieve teething pain.

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"The day care proceeded to tell me it was because of his necklace that got wrapped around his neck during his nap and that it was my fault," Morin said. Deacon was pronounced dead in the hospital five days later.

When amber teething necklaces first started popping up in parenting circles about a decade ago, they were most popular among homeopathic and New Age-leaning types. But now, thanks in part to their appeal among some celebrities and their widespread availability, this decidedly crunchy fad has seeped into the mainstream. Children's stores, boutiques, big box stores like Walmart and online retailers like Etsy and Amazon sell various versions of the jewelry.

And for parents looking to assuage their children's teething pain "naturally," the beads' promises make for an easy sell: String them around your baby's neck, marketing materials say, and a purported pain-relieving substance called succinic acid will leach from the beads, seep through the skin and enter the bloodstream to ease pain.

But there's no scientific data to show that wearing amber bead necklaces provides any kind of pain relief, said Dr. Howard Jeffries, M.D., a pediatrician and medical consultant for K Health, an app that offers medical care online. (In fact, experts have said it would be physically impossible.) And the Food and Drug Administration has not approved any teething jewelry products and has warned against using them.

"We have, however, received very serious reports of death and choking when using these products," said Dr. Scott Gottlieb, M.D., who was F.D.A. commissioner when we spoke. (Dr. Gottlieb resigned from the agency in the spring of 2019.)

Children can stop breathing if the jewelry wraps too tightly around their throats, or if the necklaces get caught on objects such as a crib. Children can also put the beads in their mouths, presenting a choking hazard.

"It's clear there is a very big risk," Dr. Gottlieb said.

Teresa Wilkes, owner of a company called The Amber Monkey in Blissfield, Mich., sells amber teething necklaces and bracelets to more than 400 stores worldwide. Like most amber teething jewelry, Wilkes's products are made from fossilized tree resin mined from the Baltic region of Northern Europe. "As a retailer and now a manufacturer," Wilkes said, "I would say that Baltic amber teething necklaces have increased in popularity over the last eight years."

The rise of these choker-style necklaces, Dr. Jeffries said, can be attributed, at least in part, to the fact that they don't require much effort to use. They're also widely available and relatively cheap, said Dr. Christina Lang, M.D., a pediatrician in Colorado; selling for around $10 to $20 online.

Behind it all, Dr. Lang said, are parents who don't want to see their babies hurting. "People don't want their kids to suffer or be uncomfortable," she said. "They see a lot of other people doing it, so it's kind of that mass effect where, 'Well, if everybody's doing it, it must be O.K.'"

When worn against the skin, such as around a neck or a wrist, amber beads are said to warm and then release a substance called succinic acid, which is then supposed to leach into the bloodstream and act as a "natural" pain reliever.

According to Aaron Celestian, Ph.D., an associate curator of mineral sciences at the Natural History Museum of Los Angeles, beads made from real Baltic amber do, indeed, contain succinic acid, but it cannot be absorbed into the skin from a necklace. "From a chemical point of view, you have to be able to release the succinic acid from the amber, and that only happens at very high temperatures," Dr. Celestian said.

And by "very high temperatures," he means around 400 degrees Fahrenheit.

"It's absurd to think about it, but yes, a person's skin would have to be at these deadly temperatures before any organics are released from the amber," Dr. Celestian said, "and even then, only a small fraction would interact with the skin as succinic acid."

So even if your baby's temperature did somehow hit 400 degrees, the infinitesimal amount of succinic acid released would be too minuscule to provide an effect.

Some manufacturers and proponents also contend that the amber beads reduce gum inflammation and drooling, but there's no evidence to back these claims either.

In a nutshell, no.

In December 2018, the F.D.A. issued a warning to parents and caregivers, cautioning that "necklaces, bracelets or any other jewelry marketed for relieving teething pain" could pose a strangulation or choking risk.

In addition to Deacon's death in 2016, the F.D.A. has reported that at least one other child in the United States has been hospitalized after choking on a teething bracelet made from wood. Yet according to a 2017 case report out of Canada, few — if any — of the products the report's authors examined (at stores and a distributor) explicitly stated such a risk on their packaging.

In another study published in 2018, researchers from Nova Scotia tested the strangulation risk of 15 amber teething necklaces purchased from retailers in Canada. Their results, published in the journal Pediatrics and Child Health, revealed that nearly half failed to open after applying 15 pounds of force (an industry safety standard) for 10 seconds; and in a separate test, eight out of 10 failed to open with 1.6 pounds of force (or the mean force that is required to block a young child's airway) for 10 seconds.

According to Morin, the product description for the necklace she placed around Deacon's neck that day in 2016 had said that it had a safety clasp. But she later found that it actually had a screw clasp, which prevented it from coming unfastened immediately when pulled on.

"I assumed it was safe since it was a baby product," Morin said of the necklace, which had been a gift purchased from the online marketplace Etsy. Etsy still sells both breakaway and nonbreakaway necklaces; and Morin is suing the e-commerce site for alleged wrongful death.

"Deacon's death was a great tragedy and our hearts are with his mother and family," a spokeswoman for Etsy said in a statement supplied to The New York Times. Because the platform did not manufacture "or directly sell" the necklace itself, Etsy believes it should not be held liable for Deacon's death. In 2018, two workers from Deacon's day care pleaded guilty to one count of child abuse each; and were each sentenced to three years of probation, in addition to some prior jail time, in connection with his death.

A surprising number of parents "are either not aware of the risk of strangulation or think it won't happen to their child," Dr. Jeffries said. In 2012, for instance, researchers from France published a small survey of 29 parents there to determine their attitudes about amber teething necklaces. They found that despite knowing the risks of strangulation and choking, parents' fears of teething symptoms largely overpowered their concerns about potential harms.

Rachael Reiser, a mother in Los Angeles who purchased amber necklaces for her then-5-month-old twins, agreed that the necklaces can be dangerously difficult to open. "My twins wore them around their necks only once," Reiser said. "They both grabbed each others' and the choking hazard was real. It took a lot of tension for the quick release to actually snap. Fortunately, I caught them in the act before anyone was injured."

According to Wilkes, owner of The Amber Monkey, the best way to use the necklaces safely is to ensure they're the right fit: not too long, and with knots between each bead to prevent them from coming off.

But the American Academy of Pediatrics and other experts have advised parents not to use them at all.

France and Switzerland have banned the sale of amber teething necklaces in pharmacies; and Ireland and Canada have issued consumer product safety warnings. In 2018, Health Canada — the department responsible for Canada's national public health — released an industry letter outlining requirements for teething necklaces for children under 3 (they must have warning labels and functioning breakaway features).

But despite the F.D.A.'s warnings, Dr. Jeffries believes that the amber jewelry is as popular as ever in the United States. "And the use seems steady and frequent," he said. In fact, Dr. Lang said that three amber-clad patients visited her office the week I spoke with her in February.

Since her son died, Morin said that when she's out and sees a baby in an amber necklace, she approaches the parent or caretaker and explains what happened to her son. "Most of the time," Morin said, "the parent will decide not to use the necklace at all."

According to the A.A.P., there are better ways to relieve teething discomfort than to use amber teething jewelry.

  • Rub or massage swollen gums with a finger, or offer teething rings (made of firm rubber) or washcloths for a baby to chew on.

  • Give your baby pain relievers such as acetaminophen (Infants' Tylenol) after 3 months of age or ibuprofen (Infants' Advil) after 6 months. Both are effective and safe for young children.

  • Dr. Lang and the F.D.A. recommend avoiding topical gels and sprays containing benzocaine, since they are not effective and can cause serious side effects.

  • The F.D.A. also does not recommend using homeopathic teething tablets, which haven't been evaluated for safety and efficacy. (The agency warned in 2017, for instance, that certain homeopathic teething products containing belladonna, a toxic substance, had inconsistent levels of the ingredient and urged consumers not to use them.)

  • The F.D.A. has said that children who experience seizures, trouble breathing, extreme sleepiness, muscle weakness or other adverse effects after using homeopathic teething products should get medical help immediately.

Lindsey Hunter Lopez is a journalist and mother of two.

Have Any Babies Choke on Amber Teething Necklaces

Source: https://www.nytimes.com/2020/04/18/parenting/amber-teething-necklaces.html