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I have only positive things to say about Permission to Mother, an autobiographical account of a thoughtful mother and clinician who courageously writes from her heart, soul, brain, and personal experience; who is open to change in her views and opinions and is not guided by the safety of rules of any group or the status quo; she is guided by love and openness to the experiences life brings her and her family. Her process benefits her and those around her and those who read her words. And to add to that, the writing style and story telling ability here make it a very enjoyable read speckled with both the humor and seriousness of life. ~Laura Keegan RN FNP, author of Breastfeeding with Comfort and Joy

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Friday, January 23, 2009

Night Nursing and Teeth

Question: I am nursing my 2 year old on demand- she nurses to sleep every night. We just went to the dentist and she suggested that I try to wean her from night nursing or at the very least wipe out her mouth when she falls asleep. Her teeth looked great no problems... I don't plan on weaning her but I am worried about her teeth... any insight on extended nursing and teeth? Thanks! Luanne

I am answering with an excerpt from Permission to Mother:

LLL recommends going within six months of the first teeth erupting. This preventive care hopefully lays the foundation for our dental health for the rest of our lives. The recommendation applies for all babies regardless of feeding method. I emphasize that breastfed babies are not exempt from meticulous dental hygiene. In my breastfeeding-skewed practice, I find more dental disease* in breastfed toddlers than I see ear infections ( I don't see much ear infections).

One of my moms, who survived multiple breastfeeding challenges to this point, was now upset after her 15 month old daughter’s visit to the dentist. Because her toddler had tooth decay, the pediatric dentist said she must stop breastfeeding at night. After all her struggle, she did not want to stop when she was finally enjoying the breastfeeding relationship.

I shared my sons’ dental history.

My first son has no dental problems. My second son who is eight years old now
had staining on his front baby teeth. The stains were there when they grew in. The
family dentist reassured me that they were just superficial and that his teeth were
solid without decay. When he was about three, he could sit still long enough for the
stains to be filed out. Neither of my two older boys had any major dental work.
Subsequently there was no reason to discuss night nursing and our family dentist
never told me to wean.

It is my third son with all the dental problems. His teeth grew in looking bad. At first I didn’t think much of it because they looked like the stains his older brother had on his front teeth. But his stains got bigger and the tips of his teeth disintegrated. Of all my sons, he was the latest to start solids and he never had a bottle (because he was with me at work). He was actually the one who was more likely to sleep through the night (or perhaps I just slept right through the nursing). I suppose I was in a sort of denial that his front teeth needed work, “Not my breastfed baby!”

His teeth looked really bad by the time he had them repaired. He was one- and-a-half. Fortunately, there is a minimally invasive pediatric dentist in town with five sons of his own who feels that breastfeeding is important to a toddler’s well-being. He will treat the decay and respect your right to continue breastfeeding. My son was sedated and caps were placed on his four upper front teeth. The dentist encourages good brushing, xylitol supplements (wipes or chewables), and nutrition (less sugar) as a part of the treatment program. Flouride treatment is individualized.

Our local La Leche League network helped me understand that breastfeeding through the night is entirely normal behavior for a toddler. If you stop breastfeeding at night, what beverage can you give that is healthier? Don’t necessarily expect any baby to sleep through the night at this age. They are not neurologically programmed for that. In fact, nursing at night is one of the best things for neurological and brain development. Formula and heavy foods may disrupt this built-in, sleep-hunger-wake feed cycle. If it’s important to you that your breastfed baby sleeps through the night, and he does, count yourself lucky.

If you have a toddler without dental problems you may get away with going to any dentist you want because breastfeeding won’t be an issue. If you have a breastfeeding toddler with caries, it becomes much more crucial to go to a breastfeeding-friendly dentist.

*Since, I wrote this two years ago, I have not seen much dental disease. David's dentist and I closely collaborate and many of my patients do get in to the dentist between the babies 1st and 2nd birthday. I'd like to think that the dental decay I see has decreased as we have worked together to provide preventative education.


Fun Mama - Deanna said...

I saw your post a few posts back about asking questions, and I had my question almost completed and then accidentally deleted it. Defeated, I thought I'd try another time. This post is the perfect place for my several part question. My pediatrician has been after me to stop night-nursing since my daughter was 4 months old. She'll be 2 this week and still nurses to go to sleep at night, and then several times during the night. I've noticed no problems with her teeth. The pediatrician is more concerned about her sleeping habits. My daughter has slept with us since she was 7 months old. She used to sleep in her crib until she woke up and then came to our bed. For the past 3 months or so, we've just put her in our bed. She does have trouble staying asleep if someone is not lying next to her. She almost never naps unless she is being held. Unless we're driving or my husband is carrying her, she rarely goes to sleep without nursing. The pediatrician says that I'm giving her terrible sleep habits, but she has NEVER been one to be laid down while sleepy. She would immediately go from sleepy to wide awake and screaming. I'm not sure if I'm doing the right thing by helping her to sleep. I've already been told by the pediatrician that they would like her to stop nursing by age 2 (that's not gonna happen).
Also, my daughter has gained only about 5 lbs since she was 9 months old. At 23 months, she was 20 lbs and still wearing some 12 months clothing. I've been threatened since she was 15 months with having her tested. She is very active and healthy, but extremely small. She eats a more balanced diet than most kids years older than her, but she doesn't always eat a large amount. Do you have any advice on helping her gain weight or any resources for why it's ok that she's so small? And any tips for the night-nursing/sleeping situation. It would be nice to have some adult time, which is hard when she's not willing to sleep alone. (I've read the book by Sears about High Need babies.) Thank you!!!

Permission to Mother said...

Deanna, Going by your words, I would probably suggest to keep following your instincts. Your scenario is very similar to other healthy families I see. I wish I could see your daughter and your interactions in person.

Erin said...

Neither one of my girls has trouble sleeping through the night. I have never heard that toddlers (mine are 2 and 4.5) "aren't wired" to sleep through the night. All of the sleep books I've read haven't mentioned it. Where did you get that from?

Permission to Mother said...

Erin, That is GREAT that your babies slept through the night. Breastfed babies usually don't. one of my three has always been a a sound night sleeper. I don't mean to imply that if your baby does sleep through the night before 2 1/2 that something may be wrong.

Here are some authors on the topic of sleep:

William Sears
James McKenna
Elizabeth Pantley
Tine Thevenin
Jack Newman
Me : )

Some Organizations with publications or papers include The Academy of Breastfeeding Medicine and LLL.

Also my 12 years working with bf mothers shows me that bf babies do wake up frequently. Subsequently I counsel mothers on these expectations. Babies who wake up frequently does not always equal tired frustrated moms.

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