Knowledge and Experiences of Families Regarding of Amber Necklaces

doi:10.21203/rs.3.rs-2064127/v1

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Knowledge and Experiences of Families Regarding of Amber Necklaces

https://doi.org/10.21203/rs.3.rs-2064127/v1

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Background

Amber necklaces have been used frequently to reduce the complaints of babies during teething. In this study, the knowledge and experience of families regarding the use of amber necklaces investigated.

Methods

The structured questionnaire was applied face-to-face to parents with a 4–24 month old baby who applied to the paediatric outpatient clinic.

Results

One hundred one families participating in the study reported that they used the amber necklace most frequently for restlessness (n = 72, 71.3%). Eighty- three percent of families reported that the amber necklace was beneficial. It determined that 2% of the babies had suffocation and 2% had problems dispersing the grains.

Conclusion

Although the parents think that the use of amber necklaces is effective during the teething period, they are not aware of the risks. It is important for healthcare professionals to inform their families about teething and especially the risks of using amber necklaces.

Amber necklaces

suffocation

teething

risks

Although parents often suppose that symptoms such as drooling, restlessness, gums swelling, appetite and sleep disorders, fever and diarrhea are caused by teething, symptoms related to teething are controversial (1,2). During this period, the most commonly used methods to comfort babies are teether, teething gels and granules, herbal products such as clove oil and oral antipryetics (3).

Amber, a natural resin, has been used for a wide variety of treatments in Ancient Greece, from the time of Hippocrates to the Middle Ages and even up to the present day, due to the belief that the succinic acid it contains has a healing effect (4,5). Theories on the mechanism of action are based on the "bio-transmitter" and "electromagnetic" effects (6). Another theory is that the succinic acid contained in amber beads is absorbed through the skin and exerts analgesia and anti-inflammatory effects (6). Since, various inflammatory cytokines such as Interleukin-1, Interleukin-10 and tumor necrosis factor, which increase during the teething period and cause symptoms, it is suggested that the anti-inflammatory effect of the amber necklace will relieve the babies during the teething period (7).

In this study, the knowledge and experience of parents about the amber necklace used during the teething period were investigated.

This study was conducted between February 1, 2022 and March 5, 2022 in a pediatric outpatient clinic. A structured questionnaire consisting of 16 questions about the use of amber necklaces was applied face-to-face by four researchers to 101 parents who had babies between 4-24 months and used amber necklaces and agreed to participate in the study. In the descriptive statistics of the data, mean, standard deviation, median minimum, maximum, frequency and ratio values were used. The normality distribution of the variables was measured by the Kolmogorov-Smirnov test. Kruskal-Wallis and Mann-Whitney U test was used in the analysis of quantitative independent data. Chi-square test, Fisher-Exact test were used in the analysis of qualitative independent data. Spearman correlation analysis was used for the presence of correlation. p<0.05 was accepted as a statistically significant. Analysis was carried out with SPSS 22.0 package program. The blinded statement of institutional review board approval was obtained on 18.02.2022(E-10840098-772.02-1173).

A total of 101 families participated in the study. Of the babies aged 4–24 months, 44 (43.6%) were girls and 57 (56.4%) were boys, with a mean age of 17.90 ± 6.41 months. The average age at which babies started using amber necklaces was 5.40 ± 2.63 months and the average necklace use of babies was 12.5 ± 6.36 months. Socio-demographic data were shown in Table 1.

The most common reasons for amber necklace use were restlessness (n = 72, 71.3%), gum itching (n = 56, 55.4%) and increased saliva secretion (n = 58, 57.4%). Amber necklaces were most commonly recommended to families by friends/relatives (n = 65, 64.4%) and purchased via the internet (n = 51, 50.5%). While 83.2% (n = 84) of the families stated that the amber necklace was beneficial, it was found that the amber necklace was very effective in 34.7% of the cases (Table 2).

No significant correlation was found between the reason for the use of amber necklaces and the sex of babies and the positive effect of amber (p > 0.05) (Table 3). There was a negative correlation between the starting time of amber necklace use and the positive effect (p < 0.01 r=-0.345). Negative relationship was found between the positive effect of amber necklace use and the number of methods used other than amber necklaces (p < 0.01 r=-0.368) (Fig. 1).

Although, it was found that 2% of the babies had suffocation risk and 2% had the problem of dispersal of the beads, the rate of warning by the doctor/nurse about the risks of using amber necklaces was 27.7% (n = 28). Also, it was detected that 42.6% of parents did not know any risk of using amber necklaces (Table 2).

As, 56.4% (n = 57) of the families reported that they cleaned the necklaces by washing them with soap and water and 43.6% (n = 44) that they did the cleaning while washing the baby.

The rate of those who used other methods in addition to the amber necklace was found to be 85.1%. The methods used by families other than amber necklaces are respectively; teether (n = 58, 57.4%), teething gels (n = 31, 30.7%), oral analgesics (n = 25, 24.8%), teething granules (n = 18, 17%) ,8) and herbal products (n = 15, 14.9%) (Fig. 2). The average number of the methods used, including amber, was 2.46 ± 0.99. Mothers stated that the most effective method was amber necklace (n = 28, 27.7%) and teething granules (n = 17, 16.8%) respectively (Table 4).

Although teething is a physiological process, parents often use drugs and treatments such as gels, teething granules, oral antipyretics, teether and herbal products to relieve their babies during this period. It is also known that amber necklaces have been used for this purpose in recent years.

Amber is a natural resin that is thought to have healing potential with the succinic acid which it contains (8). Teething necklaces and bracelets were designed based on the hypothesis that amber would be effective in symptoms related to inflammation during teething. In a study, it was reported that amber necklaces were most commonly used to prevent pain (9). In our study, the most common reason for use was restlessness with a rate of 71.3%, followed by increased salivation with 57.4% and gingival itching with 55.4%.

In the study conducted by Taillefer et al., the average age of starting to use an amber necklace was 4.2 months, while it was 5.40 ± 2.63 months in our study (10).

Amber necklaces are often purchase online or given as gifts (9, 10). In a study conducted in Turkey, it was determined that physicians do not recommend the use of amber necklaces (11). It was found that the 50.5% of the parents bought the amber necklaces from the internet and 18.8% of the families had them as a gift.

In a study from Australia, it was determined that succinic acid was not released from the beads of the amber necklace, therefore there was no scientific evidence to support its effectiveness (6). But in some studies, amber necklace use have benefit on teething symptoms. In the study of Machet et al., it was determined that 33.3% of the cases benefited highly from amber necklaces, and 40.7% benefited moderately (9). In our study, 83.2% (n = 84) of the families reported that the amber necklace was beneficial, 34.7% reported that the amber necklace was highly effective, and 16.8% reported that it was ineffective.

It is known that amber necklaces have a significant safety risk. The primary risk associated with the use of amber necklaces is the possibility of suffocation. As a matter of fact, cases resulting in injury, suffocation and death related to the use of amber necklaces have been reported in the literature (12–14). In our study, aspiration risk was found as a result of 2% suffocation and 2% dispersion of beads.

In a study conducted in France, although life-threatening risks were mentioned in interviews with families of babies wearing amber necklaces, only 2 out of 13 families stopped using the necklace. Also, it was detected that 92% of the families were not informed about the risks by any sales representative (10). In our study, 72.3% of the families were not warned about the risks of using amber necklaces, and 42.6% were not informed about the risks.

In a study about the infection risk of amber necklaces, bacterial colonization was found in the necklaces at a rate of 88.9%, despite regular cleaning (9). In our study, infection did not develop in any of the cases.

In a study among Australian parents, teethers (65%) and paracetamol (60%) were the most commonly used methods during teething (15). Acetaminophen or ibuprofen (80%) and teether (59%) were found to be the most commonly recommended methods by family physicians and pediatricians (15). Most frequently used non-amber necklace methods during teething were teether with 57.4%, gel with 30.7% and analgesics with 24.8%. Amber necklace was reported to be the most effective method in 27.7% of the cases.

Although teething is a physiological process, parents use different methods to comfort their babies during this period. The parents are more satisfied with the use of amber necklaces, which have been increasingly used in recent years, compared to other methods, but they do not have information about the risks. More studies are needed about the effectiveness of amber necklaces, and parents should be warned about the risks by healthcare professionals.

Ethics approval and consent to participate

Ethical Approval was obtained from Ethics Committee of Non-Interventional Studies at Istanbul Medipol University (E-10840098-772.02-1173).

All methods were performed in accordance with the ethical standards as laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent was obtained from all participants.

Consent for publication

Not applicable

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

There are no competing interests.

Funding

We report no funding.

Authors' contributions

All authors read and approved the final manuscript.

MHD, EHO, EO and EH collected the data. All authors contributed data and analysis tools. BA, MB and NK conceived and designed the analysis. BA performed the analysis. EH wrotes the introduction part of the article. EHO wrote the methods part of the article. MHD wrote the results part of the article. EO wrote the discussion and conclusion parts of the article. NK was the general writer. BA, MB and NK checked the article.

Acknowledgements

Not applicable

Macknin ML, Piedmonte M, Jacobs J, Skibinski C. Symptoms associated with infant teething: a prospective study. Pediatrics. 2000 Apr;105(4 Pt 1):747–52. doi:10.1542/peds.105.4.747.
Sarrell EM, Horev Z, Cohen Z, Cohen HA. Parents' and medical personnel's beliefs about infant teething. Patient Educ Couns. 2005 Apr;57(1):122–5. doi:10.1016/j.pec.2004.05.005.
Cashman JN. The mechanisms of action of NSAIDs in analgesia. Drugs. 1996;52(Suppl 5):13–23. doi:10.2165/00003495-199600525-00004.
Riddle JM. Amber in ancient pharmacy. The transmission of information about a single drug. Pharm Hist. 1973;15:3–17.
Markman L. Teething: facts and fiction. Pediatr Rev. 2009 Aug;30(8):e59–64. doi:10.1542/pir.30-8-e59.
Nissen MD, Lau ETL, Cabot PJ, Steadman KJ. Baltic amber teething necklaces: could succinic acid leaching from beads provide anti-inflammatory effects? BMC Complement Altern Med. 2019 Jul 5;19(1):162. doi: 10.1186/s12906-019-2574-9. PMID: 31277614.
Shapira J, Berenstein-Ajzman G, Engelhard D, Cahan S, Kalickman I, Barak V. Cytokine levels in gingival crevicular fluid of erupting primary teeth correlated with systemic disturbances accompanying teething. Pediatr Dent. 2003 Sep-Oct;25(5):441–8.
Strieder AP, Aguirre PEA, Lotto M, Cruvinel AFP, Cruvinel T. Digital behavior surveillance for monitoring the interests of Google users in amber necklace in different countries. Int J Paediatr Dent. 2019 Sep;29(5):603–14. doi:10.1111/ipd.12500. Epub 2019 Apr 10.
Machet P, Lanotte P, Giraudeau B, Leperlier M, Tavernier E, Maruani A. Amber necklaces: reasons for use and awareness of risk associated with bacterial colonisation. Eur J Dermatol. 2016 Dec 1;26(6):580–585. doi: 10.1684/ejd.2016.2871.
Taillefer A, Casasoprana A, Cascarigny F, Claudet I. Port de colliers de dentition chez le nourrisson [Infants wearing teething necklaces]. Arch Pediatr. 2012 Oct;19(10):1058-64. French. doi: 10.1016/j.arcped.2012.07.003. Epub 2012 Aug 24.
Güçyetmez Topal B, Falay SB. Do The Physicians Recommend The Use of Amber Jewelry for Teething Symptoms? Güncel Pediatri. 2020;18(1):63–73.
Cox C, Petrie N, Hurley KF. Infant Strangulation from an Amber Teething Necklace. CJEM. 2017 Sep;19(5):400–3. doi:10.1017/cem.2016.342.
Abdulsatar F, Matsui D, Miller M, Taheri S. Teething necklaces and bracelets pose significant danger to infants and toddlers. Paediatr Child Health. 2019 May;24(2):132–3. doi:10.1093/pch/pxy155.
Soudek L, McLaughlin R. Fad over fatality? The hazards of amber teething necklaces. Paediatr Child Health. 2018 Apr;23(2):106–10. doi:10.1093/pch/pxx158.
Wake M, Hesketh K, Allen M. Parent beliefs about infant teething: a survey of Australian parents. J Paediatr Child Health. 1999 Oct;35(5):446–9. doi:10.1046/j.1440-1754.1999.355395.x.s.

Table 1. Sociodemographic Data

	Mean±std min-max	Median
Age (month)	17,90±6,41 5,0-24,0	19,0
Usage duration (month)	12,50±6,36 0,0-23,0	14,0
Starting time (month)	5,40±2,63 1,0-13,0	6,0
	Boy	Girl
Gender	n=57 (%56,4)	n=44 (%43,6)

Table 2. Data About Amber Necklace Use

		n	%
Information source	Physician	1	1,0
	Friend/relative	65	64,4
	Social media	35	34,7
Purchased from	Internet	51	50,5
	Store	31	30,7
	Gift	19	18,8
	Pharmacy	0	0,0
Reason of use*	Restlessness	72	71,3
	Increased salivation	58	57,4
	Itching of gums	56	55,4
	Crying	22	21,8
	Redness/swelling	16	15,8
	Anorexia	13	12,9
Usefulness	None	17	16,8
	A little	14	13,9
	Moderate	35	34,7
	Great	35	34,7
Cleaning method	Washing with soap and water	57	56,4
Cleaning method	While washing the baby	44	43,6
Being informed about risks	No	73	72,3
Being informed about risks	Yes	28	27,7
Known risk by parent*	No risk	43	42,6
	Tangling on the neck	47	46,5
	Aspiration of the beads	24	23,8
	Skin Infection	5	5,0
Problems during usage	No	97	96,0
	Strangulation	2	2,0
	Dispersal of the beads	2	2,0
	Skin Infection	0	0,0

* Since; participants can indicate more than one reason for use, the total may be more than 100%.

Table 3. The relationship between amber necklace effectivity, gender and reason for use.

		Effectivity
		Yes		No
		n	%	n	%	p
Gender	Girl	7	15,9	37	84,1	0,828
Gender	Boy	10	17,5	47	82,5	0,828
Purpose of use*	Crying	4	18,2	18	81,8	0,848
	Restlesness	14	19,4	58	80,6	0,269
	Anorexia**	4	30,8	9	69,2	0,225
	Itching of gums	9	16,1	47	83,9	0,82
	Redness/swelling**	1	6,3	15	93,8	0,296
	Increased salivation	7	12,1	51	87,9	0,137

*Chi- Square test. **Fisher-Exact test

Table 4. Efficacy of Methods

	n	%
Amber Necklace	28	27,7
Teething Granules	17	16,8
Analgesics	15	14,9
Teether	15	14,9
Gel	13	12,9
Herbal Medicine	8	7,9
None	5	5

No competing interests reported.

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Editorial decision: Major revision
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You are reading this latest preprint version

Knowledge and Experiences of Families Regarding of Amber Necklaces

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Version 1

Abstract

Background

Methods

Results

Conclusion

Figures

Background

Methods

Results

Discussion

Conclusion

Declarations

References

Tables

Additional Declarations

Status:

Version 1