Dr. Himanshu Tyagi

Health considerations when bottle-feeding

If you decide not to breastfeed, or are unable to breastfeed, commercial iron-fortified formulas can give your baby the nutrition he or she needs. Infant formulas have the right amounts of protein, calories, fat, vitamins, and minerals for growth. However, formula does not contain the immune factors that are in breastmilk. The immune factors in breastmilk help prevent infections and other health conditions throughout a baby's life.

Infants who take enough iron-fortified infant formula usually don’t need vitamin and mineral supplements. However, the American Academy of Pediatrics recommends vitamin D supplementation for all babies drinking formula until they are drinking at least 32 ounces a day. Fluoride supplements are recommended for babies whose primary water supply is not fluoridated. Check with your baby's healthcare provider about vitamin D and fluoride supplements.

Types of infant formula

• Cow's milk-based formula. Most infants should be able to tolerate a standard cow's milk formula. Cow's milk formulas are modified to be closer to human milk. These formulas have lactose as the carbohydrate (sugar) source. They are available in ready-to-feed cans, liquid concentrate, and powder. Regular cow's milk is not an appropriate source of nutrition for a human baby.

• Soy-based or lactose-free formulas. These formulas are used if an infant can’t tolerate lactose, which is rarely a significant problem in babies. They don’t contain lactose as the sugar source. As many as 50% of all infants who are allergic to cow's milk formula will also be allergic to soy-based formulas. Talk with your baby's healthcare provider before changing formulas. Vegetarian parents may prefer soy-based formulas. But they should be aware that breastfeeding is still the best option.

• Specialized formulas. There are special formulas for babies who are premature or who have certain rare disorders or diseases. These formulas may have special directions for use. They are prescribed by the baby's healthcare provider.

• Hydrolyzed formulas. Hydrolyzed formulas are easier to digest. They may be used in babies at risk for allergies. They are more expensive than regular formulas. Talk with your baby's healthcare provider before using these formulas.

• Low iron formulas. These formulas are not recommended.

Helpful hints for feeding your baby

• Breastmilk only is the ideal feeding for at least 6 months. This means no water, sugar water, or formula.

• Wait until breastfeeding is well established before giving your baby breastmilk in a bottle.

• Working mothers can use a breast pump on break time and refrigerate or freeze the milk for later use as a bottle-feeding. Refrigerated breastmilk should be used within 24 hours after pumping. Frozen breastmilk is good for several months in the freezer. Fathers and other family members can be involved in feeding time if breastmilk is offered from a bottle occasionally.

• Offer cow's milk-based formula with iron as first choice of formula if not breastfeeding.

• Keep your baby on breastmilk or baby formula until he or she is 1 year old. After this time, you may switch to whole milk. Children under 2 years old should not drink skim or low-fat milk.

• It’s important to follow the formula preparation directions exactly as directed on the packaging. Using too much water can result in poor weight gain. It's also important to discuss your water supply with your child's healthcare provider. In some areas, water must be boiled first, or bottled water should be used.

• Bottles should never be propped up.

• Babies should never be put to sleep with a bottle. This can cause cavities to develop.

• All babies, whether breast or bottle fed, should be offered a feeding whenever they show signs of hunger.

Baby Bottle Tooth Decay

 Tooth decay in infants and toddlers is often referred to as Baby Bottle Tooth Decay, or Early Childhood Caries. Children need strong, healthy teeth to chew their food, speak and have a good-looking smile. Their first teeth also help make sure their adult teeth come in correctly. It’s important to start infants off with good oral care to help protect their teeth for decades to come.

You can help prevent your baby from getting cavities or developing what is called Baby Bottle Tooth Decay or Early Childhood Caries, by beginning an oral hygiene routine within the first few days after birth. Start by cleaning your baby’s mouth by wiping the gums with a clean gauze pad. This helps removes plaque that can harm erupting teeth. When your child's teeth begin to come in, brush them gently with a child's size toothbrush and a small amount of fluoride toothpaste, about the size of a grain of rice. For bottle feedings, place only formula, milk or breast milk inside and avoid using sugary beverages such as juice or soda. Infants should finish their bedtime and naptime bottle before going to bed.

Dental Emergencies

Accidents can happen anywhere, anytime. Knowing how to handle a dental emergency can mean the difference between saving and losing your child’s permanent tooth. For all dental emergencies, it’s important to take your child to the dentist or an emergency room as soon as possible.

Here are some tips if your child experiences a common dental emergency:

• For a knocked-out tooth, keep it moist at all times. If you can, try placing the tooth back in the socket without touching the root. If that’s not possible, place it in between your child’s cheek and gum, or in milk. Call your dentist right away.
• For a cracked tooth, immediately rinse the mouth with warm water to clean the area. Put cold compresses on the face to keep any swelling down.
• If your child bites his tongue or lip, clean the area gently and apply a cold compress.
• For toothaches, rinse the mouth with warm water to clean it out. Gently use dental floss to remove any food caught between the teeth. Do not put aspirin on the aching tooth or gum tissues.
• For objects stuck in the mouth, try to gently remove with floss but do not try to remove it with sharp or pointed instruments.

Thumbsucking

Sucking is a natural reflex and infants and young children may suck on thumbs, fingers, pacifiers and other objects. It may help them relax or make them feel safe or happy. Most children stop sucking by age 4. If your child continues to thumb suck that after the permanent teeth have come in, it can cause problems with tooth alignment and your child’s bite. The frequency, duration and intensity of a habit will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs. If you are worried about your child’s sucking habits, talk to your dentist or consult your child's pediatrician.

Space Maintainers

Space maintainers help “hold space” for permanent teeth. Your child may need one if he or she loses a baby tooth prematurely, before the permanent tooth is ready to erupt. If a primary tooth is lost too early, adult teeth can erupt into the empty space instead of where they should be. When more adult teeth are ready to come into the mouth, there may not be enough room for them because of the lost space. To prevent this from happening, the dentist may recommend a space maintainer to hold open the space left by the missing tooth.

Sealants

Sealants are a fast and easy way of protecting your child’s teeth that act as barriers to cavity-prone areas. They are usually applied to the chewing surfaces of back teeth and sometimes used to cover deep pits and grooves. Sealing a tooth is fast and there is virtually no discomfort. As long as the sealant remains intact, the tooth surface will be protected from decay. Sealants hold up well under the force of normal chewing but may have to be reapplied if needed. Both primary and permanent teeth can benefit from sealants. Ask your dentist if sealants will help your child.

Mouthguards

Mouthguards can help protect your child from a dental emergency. They should be worn whenever your child is participating in sports and recreational activities. Mouthguards cushion blows that would otherwise cause broken teeth, injuries to the lips and face and sometimes even jaw fractures. If your child participates in such pastimes, ask your dentist about custom-fitted mouth protectors.

Malocclusion

Malocclusion, or bad bite, is a condition in which the teeth are crowded, crooked or out of alignment, or the jaws don’t meet properly. This may become particularly noticeable between the ages of 6 and 12, when a child’s permanent teeth are coming in. If not treated early, a bad bite can make it difficult to keep teeth and gums clean where teeth are crooked or crowded, increasing the risk for cavities and gum disease.

Bad bites can also:

• Affect proper development of the jaws.
• Make the protruding teeth at risk for chips and fractures.
• Affect eating and speaking.
• Make some teeth more likely to wear abnormally or faster than those that are properly aligned.

Anesthesia and Sedation

Your dentist might recommend that your child be administered anesthesia or sedation to relax them in order to safely complete some dental procedure.    

• CONCLUSION : When your child’s first tooth appears, talk to your dentist about scheduling the first dental visit. Treat the first dental visit as you would a well-baby checkup with the child’s physician. Remember: starting early is the key to a lifetime of good dental health. Encourage healthy eating habits.