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Ask Dr. Sears: Nursing Caries

Q: My son was diagnosed at thirteen months with nursing caries. I have cut down his nighttime feedings to one or two. I have also been wiping and brushing his teeth, day and night. My question is, what else should I do? My son is not ready to be weaned and neither am I, but I want to protect his teeth.

A: It's good that your child's dentist detected this problem early, and you are wise to seek remedies to prevent further tooth decay. Erosion of the teeth enamel is much more common with nighttime bottlefeeding, but it does also occasionally occur in breastfed babies. When babies fall asleep, saliva secretion decreases, so they lose the natural rinsing action of saliva that they have during daytime feeding. The sugars in the milk bathe the teeth during the night and eventually can cause tooth decay. Nursing caries are more prevalent in babies who enjoy frequent nighttime feedings. I dub them, "all night suckers." Try these tips to continue letting your baby enjoy the health and developmental benefits of breastfeeding, yet protect his precious teeth from decay.

Lessen night feedings. It's common for toddlers to increase their number of night nursings. They get so busy during the day and forget to nurse, so they make up for it at night. Purposely increase the number of daytime feedings by nap nursing -- choose a couple times during the day when you are the most tired, and lie down and nurse your baby. Toddlers also get distracted easily during daytime nursing. So, take your baby in a dark, quiet room and get down to the business of nursing. Ease him into a feeding pattern that helps him learn that daytime is for feeding and nighttime is for sleeping.

Tank up baby with a before-bed feeding. Make the last feeding of the day a big one. Give your baby a feeding of solid food later in the evening. Mashed avocado is a filling food for babies because it is high in healthy fats and fiber. Besides nursing your baby to sleep, consider awakening your baby just before you go to bed for another tank-up feeding.

Brush his teeth frequently. The two most important times to cleanse those pearly whites is right after the first feeding in the morning and after the last feeding at night. Try a soft-bristle brush or wrap gauze around your index finger and use it as a toothbrush. Nursing carries are most prominent in the front teeth, especially along the gum lines. Be sure to curve your finger, or the brush, enough to cleanse behind the teeth. It often takes two people to brush a baby's teeth, so you and Dad sit facing one another knees to knees and stretch baby across your laps, with his head on your lap. Then you can brush his teeth from above, which helps you get better access to the teeth. Dad can hold the squirming baby while you brush the teeth. You can also give your toddler his own toothbrush and capitalize on his natural desire to mimic. While you are brushing your teeth, encourage him to do likewise.

Consider a fluoride supplement. Since babies usually don't drink enough water, especially if you drink unfluoridated bottled water, ask your dentist for the appropriate dosage of a fluoride supplement for your baby. This could be in the form of daily fluoride drops or you could use no more than a pea-sized dab of fluoridated toothpaste. Concerning fluoride, be sure not to give more than your dentist prescribes, since too much fluoride can weaken the enamel instead of strengthen it.

Avoid sticky stuff. Because of the choking hazard, baby is too young to suck on hard candy anyway, but with toddlers, avoid caramel and sweets that stick to the teeth.

Substitute night "nursings." The term "nursing" does not mean only breastfeeding; it implies any method of comforting. A father can "nurse," too. If your baby needs a middle-of-the-night sucking to soothe him back to sleep, let him suck on your finger or knuckle. Sometimes a lullaby will do just that -- lull a baby back to sleep. For babies who want a nighttime bottle, try the trick I call "watering down" -- each night gradually dilute the formula with increasing amounts of water until your baby's bottle is 100 percent water.