Unlike the majority of media outlets, my initial reaction to this photo was not to judge how well adjusted or possibly how much therapy this child might need someday. Due to the fact that I am a Pediatric Dentist, and therefore a tooth nerd, my first thought when I saw this photo was, "Good Lord, I really hope his mom is a good brusher".
The article and many news pundits have labeled the behaviors involved in this style of parenting "extreme". From a dental standpoint the frequency of food intake, often multiple times per hour during infancy, qualifies as such. Although attachment parenting has become controversial partly because of the frequency and duration of breastfeeding, it is not the only parent behavior that includes "extreme" frequency feeding or as some call it "grazing". Many American parenting styles lend themselves to frequent feeding. This includes ad lib breastfeeding, ad lib bottle use, sippy cups, frequent snacking and using candy as a reward. That's not to say that these things are wrong when used appropriately. It's just important to pay attention to how often you are using them. Several of you, who have been in the office, may have heard me talk about how cavities are a disease of frequency. Simply put, the more often you eat or drink, the more often the bacteria that live in your mouth get to eat and drink. The acids that make holes in your teeth are a normal byproduct of bacterial metabolism. Therefore, the more often you eat, the more often bacteria get to make acids, and the more likely you are to get cavities. Think of it this way; if children only ate three times per day, then the bacteria in their mouths would only get three chances to make cavities. When children get frequent snacks or ad lib feeding, there are many more opportunities for them to get cavities.
So what is the best strategy to prevent cavities in the face of frequent feeding? The best approach is to pay attention to how often your child is eating. In addition to their regular three meals a day, the two snacks in daycare, the lollipop reward for being quiet at the grocery store, and the sippy cup of juice that they nursed all afternoon, all count as meals. The ideal way to minimize your child's risk for cavities would be to limit the amount of times per day that they eat. I would recommend three meals and one snack with only water to drink in between meals. If you find this to be unrealistic or challenging to do, then your next best option is to adjust your oral hygiene regimen. Brushing two times per day is not going to be enough for a child who eats this frequently. Consider brushing or at least wiping your child's teeth with a moist cloth after every "meal", and fluoride tooth paste twice per day is a must for frequent feeders. If in doubt, consult your child's Pediatric Dentist.
Parenting is a challenging undertaking. My opinion and understanding has changed multiple times over the lives of my 7 year old daughter and 4 year old son. When choosing your style, it is important to consider how the behaviors affect all aspects of your child's health and routine. The take home message here is this; if you choose a parenting style that is "extreme" in regard to feeding, then you need to adjust your child's oral health care to that "extreme". Good luck and happy brushing.
I'd like to see any research you know of on breastfeeding causing cavities.
ReplyDeleteThis is a great request. I confess that I intentionally over generalized and avoided including a great deal of specific research because I don’t want these articles to be overly technical. I do want them to be thought provoking and to impart a message. The central message here was that frequent eating behaviors inherently put children at a higher risk for cavities. The solution for this is pretty basic. If you eat more often, you need to brush more often. That said I think that this is a great forum for discussion and I am happy to pull some research in, if the question is asked.
DeleteFirst and foremost I hope that no one thinks that I am in anyway discouraging breastfeeding. There are many studies that demonstrate that human breast milk provides the best possible nutrition for infants. Also epidemiologic research suggests that human milk and breast feeding of infants provide general health, developmental, nutritional, social, economic, and environmental advantages while significantly decreasing the risk for a large number of acute and chronic diseases.
A lot of advocates for breastfeeding talk about how human breast milk is better because it does not cause cavities. Research supports that in a direct relationship this is true. However that same research shows that in a dynamic model human breast milk may indirectly increase the risk for cavities. The American Academy of Pediatric Dentistry put a lot of research into their policy statement on Early Childhood Caries and nutrition, which can be found on their website (aapd.org). This policy is consistent with the American Academy of Pediatrics. I would consider that policy and the following article as good, peer reviewed research on the subject. The findings are somewhat confusing so I will do my best to summarize it here.
The most often cited research article in regard to human breast milk was done at the University of Minnesota in 1999 (Investigation of the role of human breast milk in caries development – Erickson et al). In this laboratory study teeth were soaked in a culture medium of human breast milk and strep mutans (the bacteria that causes cavities). The pH of the culture medium didn’t change and the teeth did not break down. Conversely when teeth were soaked in a culture medium of 10% Sucrose and strep mutans, the pH of the solution dropped and the enamel began to break down (cavities started to form). This research was very well done and the group concluded that by itself, in a laboratory setting, human breast milk is noncariogenic (does not cause cavities). This was a well controlled study with very few variables (direct model). This conclusion is often touted as clear evidence that children who are breast fed should not get cavities. I believe that this sometimes gives parents a false sense of security.
We know that outside of the laboratory, teeth are never exposed to only breast milk. The real world is a dynamic model with many variables. Parents normally start to add some solid foods to their children’s diet around the time that their teeth begin to come in. In the same study above when teeth were soaked in a medium of strep mutans, human breast milk, and a 10% sucrose solution; there was a pH change and a higher amount of tooth structure breakdown. This was a puzzling finding that has been repeated in other studies. Researchers postulate that although human breast milk by itself does not cause cavities, when combined with any other nutritional source, it probably facilitates the growth of more aggressive oral bacteria. Therefore breast milk can indirectly put children at a higher risk for cavities. This scenario is probably more true to life and is what is reported clinically by pediatric dentists.
I believe that breast milk is highly beneficial for children. However, in the face of laboratory research and clinical evidence the notion that breast milk does not cause cavities imparts a false sense of security. This brings us back to the take home message, just be diligent about your child’s brushing. Thanks for the question.