From six months of age the objective of cup feeding is different from that of the neonatal period. At this stage, progression from sucking to drinking is paramount. An open cup or, at the very least, a free-flowing feeder is therefore recommended.

A number of papers linking use of lidded cups to dental caries have been published (Cone 1981, Errant 1992, Kovesi 1992, Roberts et al 1993) and the terms ‘nursing bottle caries’, ‘sucking cup caries’ and ‘early childhood caries [ECC]’ (Reagan 2002) have been coined. These terms are now synonymous with inappropriate feeding practices (Ripa 1988).

The cause of such caries is thought to be the pooling of formula milk or sugary drinks in a baby’s mouth. Bacteria called streptococcus mutans thrive in a combination of sugars, low levels of saliva and a low pH level in saliva. This produces high levels of acid which destroy tooth enamel. The bacteria are spread by saliva to saliva contact with adults already infected. They do not colonise a baby’s mouth until their teeth appear. Close contact and kissing is obviously impractical to avoid with young babies and there is reassuring evidence to support the immunisation effect of this contact before a baby’s teeth erupt (Aaltonen 1994). Levels of this bacterium have been found to be more than 100 times higher in children with caries than those without (Reagan 2002).

The risk of a child developing dental caries is greatly increased by grazing on sugary drinks or formula feeds, which, in contrast to breast milk, are known to be particularly corrosive to enamel (Erickson 1998).

So what of full-term breastfeeding, especially night time feeds, which can be regular and go on for years?

© Sharon Trotter

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This article can also been seen at MIDIRS Midwifery Digest 16:3 2006