Baby Bottle Syndrome

Baby-Bottle Syndrome Putting an infant to bed with a bottle can result in aspiration or decay of all the upper teeth and the lower posterior teeth (Nainar & Mohummed, 2004); (Fig. 28. 21). Decay occurs because while an infant sleeps, liquid from the propped bottle continuously soaks the upper front teeth and lower back teeth (the lower front teeth are protected by the tongue). The problem, called baby-bottle syndrome, is most serious when the bottle is filled with sugar water, formula, milk, or fruit juice. The carbohydrate in these solutions ferments to organic acids that demineralize the tooth enamel until it decays.To prevent this problem, advise parents never to put their baby to bed with a bottle. If parents insist a bottle is necessary to allow a baby to fall asleep, encourage them to fill it with water and use a nipple with a smaller hole to prevent the baby from receiving a large amount of fluid. If the baby refuses to drink anything but milk, the parents might dilute the mil k with water more and more each night until the bottle is down to water only. | | |FIGURE 28. 21 Baby-bottle syndrome. Notice the extensive decay in the upper teeth. (K. L.Boyd, DDS/Custom Medical Stock Photo. ) | Obesity in Infants Obesity in infants is defined as a weight greater than the 90th to 95th percentile on a standardized height/weight chart. Obesity occurs when there is an increase in the number of fat cells due to excessive calorie intake. Preventing obesity in infants is important because the extra fat cells formed at this time are likely to remain throughout childhood and even into adulthood. If a child becomes obese because of overingesting milk, iron-deficiency anemia may also be present because of the low iron content of both breast and commercial milk.Once infant obesity begins, it is difficult to reverse, so prevention is the key (Benton, 2004). Overfeeding in infancy often occurs because parents were taught to eat everything on their plate, and they continue to i nstill this concept in their children. This appears to be the case most often with formula-fed infants whose parents urge them to empty their bottle or finish a cereal serving. It can occur any time parents automatically feed an infant when the child cries, rather than investigating what the cry might really mean. As a general rule, an infant should take no more than 32 oz of formula daily.When solid food is introduced, a bottle of water can be substituted for formula at one feeding. Nonfat milk should not be given because it contains so little fat that essential fatty acid requirements may not be sufficient to ensure cell growth. Another way to help prevent obesity is to add a source of fiber, such as whole-grain cereal and raw fruit, to an infant's diet. These prolong the stomach-emptying time, so they can help reduce food intake. Caution parents about giving obese infants foods with high amounts of refined sugars, such as pudding, cake, cookies, and candy.Encourage parents to lea rn more about balanced nutrition and to provide this for their entire family. Care of Teeth It is well accepted that exposing developing teeth to fluoride is one of the most effective ways to promote healthy tooth formation and prevent tooth decay. The most important time for children to receive fluoride is between 6 months and 12 years of age. A water level of 0. 6 ppm fluoride is recommended because this is the level that protects tooth enamel yet does not lead to staining of teeth.In communities where the water supply does not provide enough fluoride, the use of an oral fluoride supplement beginning at 6 months or the use of fluoride toothpaste or rinses after tooth eruption is recommended (AAP, 2001). P. 849 Teach parents to ask about the presence of fluoride in the drinking water in their community and help them to determine what, if any, supplementation is necessary. Breast-fed infants do not receive a great deal of fluoride from breast milk, so it may be recommended they be g iven fluoride drops once a day.Teach parents to begin â€Å"brushing† even before teeth erupt by rubbing a soft washcloth over the gum pads. This eliminates plaque and reduces the presence of bacteria, creating a clean environment for the arrival of the first teeth. Once teeth erupt, all surfaces should be brushed with a soft brush or washcloth once or twice a day. Children lack the coordination to brush effectively until they are school-age, so parents must be responsible for this activity well past infancy. Toothpaste is not necessary for an infant, because it is the scrubbing that removes the plaque.