Night nursing=cavities=NOT true!!!! - Page 2

[AJP]

I think fingering s. mutans as the culprit in ECC is simplistic. IMO, when there's a high level of the bacteria it's likely because the weak/demineralized enamel gives them a cozy home where it's difficult to manually remove them by cleaning, and they can just reproduce like crazy, which then starts a downward spiral of decay. The bacteria don't cause the problem, it's more of an opportunistic infection because the environment is right for them. The enamel weakness stems from a potentially complex interplay of many other factors, many of which were named in that article, but largely I think the root is nutritional. I think many cases of kids with at-risk enamel developing ECC are because of a multi-generational decline in the nutrient levels in our modern diet, which carries through and worsens with each succeeding generation. I also think sometimes it can be reversed in one generation and sometimes it can't, depending on severity and how many specific factors are involved. But I know my worldview about pathogens and their relationship to humanity is largely the opposite of conventional medical theory.

[esokitty]

My 17 month old son is facing GA surgery and 4 crowns for ECC.

We have good to great family dental health history. I had 2 cavities filled as a teen, and no problems since. Baby-daddy has no cavities or fillings at all.

My son eats a very reduced processed sugar diet - he drinks maybe an ounce of juice watered down 1:4 with water per day (morning and lunch, never dinner).

We brush, religiously, 2 times a day.

we have co-slept and night nursed on demand his whole life.

At 4 months, his pediatrician recommended completely stopping night nursing. I listened, but thought "she also recommends sleep training and no co-sleeping" I did hours of research here, and other places on the internet. I chalked her advice up to "doctors don't always know what's best, I'm going to trust my instincts and Dr. Brian Palmer's research, and continue what I feel is right"

You can find medical opinions and research on just about anything. Here's the latest study that's hurting my guilty conscience:

http://jdr.iadrjournals.org/cgi/content/full/85/1/85
"A retrospective cohort study on ECC and associated factors was conducted among mothers with 25- to 30-month-old infants in a community where prolonged breastfeeding was common practice. All infants who consumed sugary supplementary food or rice that was pre-chewed by the mother, or who fell asleep with the breast nipple in their mouths, had ECC. Infants without those habits, and who were breastfed up to 12 months, had no ECC. Breastfeeding during the day beyond the age of 12 months was not associated with ECC, but infants who were breastfed at night > 2 times had an OR for ECC of 35 (CI 6-186), and those who were exposed to > 15 min per nocturnal feeding had an OR for ECC of 100 (CI 10-995). The present study indicates that, in this population, besides the consumption of sugars and pre-chewed rice, nocturnal breastfeeding after the age of 12 months poses a risk of developing ECC."

I guess all I'm saying, is be very confident in your parenting decisions, and somehow try to brace for the possibility that even your instincts could be wrong.

[flowmom]

North American families who practice extended night-time breastfeeding are in the extreme minority, and to my knowledge there is no research on ECC that applies directly to us. Correct me if I'm wrong! The research has been done in more traditional societies, however.

In the Myanmar study cited by esokitty, the total time spent breastfeeding in a 24-hr cycle was significantly related to the incidence of ECC. Nighttime breastfeeding, specifically, was also found to be a risk factor for ECC:

Falling asleep with the nipple in the mouth was a significant risk factor for ECC:

• fell asleep with nipple in mouth - 100% had ECC
• did not fall asleep with nipple in mouth - 29% had ECC

Among 12+ mo toddlers, nighttime breastfeeding was a significant risk factor for ECC:

• breastfed 2+ times per night - 52% had ECC
• breastfed 1-2 times per night - 29% had ECC

• breastfed at night for more than 15 min. per feeding- 89% had ECC
• breastfed at night for less than 15 min. per feeding - 7% had ECC

ATanzanian study found that allowing 1-4 year olds to sleep with the nipple in their mouths is strongly associated with ECC.

Originally Posted by moonfirefaery

The breastmilk is deposited at the back of the mouth near the throat and is usually swallowed immediately. It barely touches the teeth at all.

Do you have any evidence for your statements above? I believe that for many children your statements are factually incorrect. I have observed breastmilk around dd's teeth at night, and I have occasionally even seen breastmilk dribble out of her mouth. I'm sure that many mothers have observed the same. A dental assistant that I was talking with expressed her view that the impact of nighttime breastfeeding in terms of ECC risk can vary a lot among children, depending on their behaviours: some children shift around more in their sleep, they lie in different positions, some might swallow more, etc. - all of these things will affect caries risk.

Originally Posted by moonfirefaery

Mothers throughout time have had to nurse their babies at night. Babies were meant to be breastfed--at night, too. Why would nature work against itself?

Clearly, breastfeeding in traditional societies was not a significant risk factor for ECC. However, in modern societies, it seems that breastfeeding (particularly at night) is a risk factor for ECC in combination with other factors (and some of those other factors may be very important!!).

Originally Posted by moonfirefaery

As you can see by the article caries in early childhood are caused by ECC, kids that have a high concentration of a certain bacteria. Nothing to do with breastmilk whatsoever.

Most studies on ECC have shown that ECC is not caused by one factor - it is a multifactorial disease. Infection by Streptococcus mutans alone is not enough to explain the distribution of ECC.

Originally Posted by moonfirefaery

Maybe a mother who has a high sugar diet, that could contribute, but there are countries were babies nurse ALL night...and ECC is less common there.

The studies that I have referenced above contradict your statement.

I think that there is pretty strong evidence that nighttime breastfeeding is a risk factor for ECC, especially if the child is 12+ mo and nursings are long and frequent. I also strongly believe that decisions about breastfeeding should take into account the health of the whole child - including emotional and physical considerations. I would not advocate weaning on the basis of the studies that I've presented above, because weaning could have unintended consequences (like an overall decrease in the quality of the child's nutrition - potentially making decay worse), but please let's look at the evidence and make informed decisions.

My 22 mo dd has severe ECC and nurses on demand day and night. My 4.5 yo ds is still nursing and he nursed on demand day and night when he was dd's age and he has perfect teeth. ECC is very baffling. In our case genetics, diet, oral hygiene, and breastfeeding patterns do not explain why one of our children has ECC and the other does not. My theory is that my nutrition was poor and my body was depleted during my second pregnancy, but that is pure speculation on my part. For whatever reason, dd got ECC and now I have to seriously look at any factors that could accelerate the progression of the decay. We are doing a lot to try to put the brakes on the ECC, and I am very reluctantly considering nightweaning dd.

to all of the mamas who are just trying to do the best for their children.