In 1994, as a result of the earlier studies, the UK Committee on Medical Aspects (COMA 1994) published their weaning report. This publication advocated the introduction of solid foods from four to six months. The report strongly recommended that infants older than six months should be introduced to drinking from a cup and suggested that the use of bottles be actively discouraged from 12 months. While the document refers to ‘bottles and reservoir feeders’, it must be emphasised that any vessel which is designed to encourage frequent sipping has the potential to damage oral health, interfere with oral muscle development and may even have a detrimental effect on speech (Eig 2002). Only open cups can truly be seen to fulfil the criteria for encouraging drinking rather than sucking.

In 2001, the WHO changed its recommendations on weaning to advocate exclusive breastfeeding for the first six months of life, with the introduction of complementary foods and continued breastfeeding thereafter (WHO 2001).

The Scientific Advisory Committee on Nutrition (SACN 2001), the body replacing the COMA panel on child and maternal nutrition, responded to the WHO recommendations in September 2001. It now agreed that: "Mothers of infants should be particularly warned of the dangers of putting fruit juice or sugar-sweetened drinks into feeding bottles or reservoir feeders for the child to hold, especially in bed. Such practices result in almost continuous bathing of the enamel with sugars and lead to severe tooth decay".

These ‘nursing bottle caries’ are not just detrimental to a child’s physical health; the increased need to undergo surgery for tooth extraction at a young age also has obvious psychological repercussions.

In the States, the American Academy of Pediatrics (AAP 2003) do not differentiate between formula feeding and breastfeeding when they conclude that children who sleep with a bottle or breastfeed throughout the night are at risk of developing ECC. Evidence is clear regarding the vast benefits of baby-led breastfeeding and future policy needs to reflect this.

The American Academy of Pediatric Dentistry (AAPD 2003) also recommends that "nocturnal breastfeeding should be avoided after the first primary tooth begins to erupt". As this could occur before six months of age, this advice could contradict that of the WHO (2001). Consistency is vital when new directives are published and communication between agencies will help to avoid confusion for parents and professionals.

© Sharon Trotter

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