Breastfeeding, Night Feeds and Cavities: What Parents Should Know

"Someone told me breastfeeding at night will rot his teeth. Do I have to stop?" I hear this worry often, usually from a tired parent who is doing a wonderful job. The short answer is no, you don't have to stop breastfeeding to protect your child's teeth. A few simple habits make a real difference.

Breastfeeding is good for your baby

Breastfeeding is recommended by health organisations worldwide and has many benefits for mother and baby. Breast milk on its own is not considered highly cavity-causing. This article is not about stopping, and how long you breastfeed is a decision for your family and your paediatrician.

So where does the risk come from?

Cavities happen when mouth bacteria feed on sugars and make acid that weakens enamel. Breast milk contains natural sugar, and risk tends to rise when several things come together after teeth appear:

• Frequent, long feeds through the night, often feeding to sleep, when saliva flow is low and milk can sit on the teeth for hours.
• Other sugars during the day, such as juice, sweetened snacks, biscuits or sweet tea.
• Teeth that are not brushed, or not brushed with fluoride toothpaste.

It is usually this combination, rather than breastfeeding alone, that leads to decay. Every child is different, and some children are more prone to cavities than others.

What about bottles at night?

Formula and cow's milk in a bottle at night carry a similar risk once teeth are present, and sometimes more, because a bottle can drip slowly into the mouth during sleep. Juice or sweetened drinks in a bottle are the most harmful.

• Try not to put your child to bed with a bottle of milk, formula or juice.
• If a bottle is part of falling asleep, gently move it earlier in the routine, then brush.
• If your child still needs something in the night, water is the safest choice for teeth.
• Aim to move from the bottle to a cup around 12 months.

Practical tips for night-feeding families

1. Start cleaning from the first tooth. Brush twice a day with a soft baby toothbrush and a rice-grain smear of fluoride toothpaste.
2. Make brushing as late as possible. Brush before the last feed if needed, and after it when you can.
3. Wipe after night feeds when practical. A clean, damp cloth or gauze over the teeth and gums takes seconds. Don't worry if it isn't possible every time; do what is realistic.
4. Gently unlatch once your baby is asleep rather than letting them stay on the breast for hours, if this works for you both.
5. No sugary drinks in bottles or cups, day or night. Water between meals is best.
6. Keep sweet foods to mealtimes and avoid sharing sweets, sweet tea or desserts with a baby or toddler.
7. Look after your own teeth. Cavity-causing bacteria can pass to babies through saliva, so avoid sharing spoons and cups.

Lift the lip once a month

Once a month, in good light, gently lift your child's upper lip and look at the front teeth near the gums. Watch for:

• White chalky lines or spots along the gumline, often the earliest sign of decay.
• Brown or yellow areas, or small holes.

If you see anything like this, book a check. Early decay can sometimes be stopped with fluoride before it needs treatment.

The first dental visit

Plan your child's first dental visit by the first birthday, or within six months of the first tooth. It is a short, friendly visit where the dentist checks the teeth, looks at feeding and brushing routines with you, and may suggest fluoride varnish. It is a good chance to ask about night feeds without anyone judging you.

A word for tired parents

Night feeds are often about comfort, closeness and getting some sleep. You are not doing anything wrong. The aim is simply to protect those new teeth while you continue what works for your family.