Anticipatory Guidance (continued)

Nutrition

• Avoiding sharing utensils (e.g., spoons) or orally cleaning a pacifier or a bottle nipple. This practice helps prevent transmission of bacteria that cause tooth decay from the parent, especially the mother, to the child via saliva.
• Continuing to encourage the child to drink from a cup. Weaning the child from the bottle by age 12 to 14 months.
• Not putting the child to sleep with a bottle or sippy cup or allowing frequent and prolonged bottle feedings or use of sippy cups containing beverages high in sugar (e.g., fruit drinks, soda, fruit juice), milk, or formula during the day or at night to prevent sugary fluids from pooling around the teeth, which can increase the child’s risk for tooth decay.
• Serving age-appropriate healthy foods during planned meals and snacks, and limiting eating (grazing) in between.
• Serving fruit, vegetables, grain products (especially whole grain), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt).
• Serving foods containing sugar at mealtimes only (not between meals), and limiting the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay. In addition, frequent consumption of foods that easily adhere to the tooth surface, such as fruit-roll-ups and candy, increases the risk for tooth decay. When checking for sugar, looking beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay.
• Encouraging the child to eat fruit rather than drink fruit juice.
• Serving the child juice in a cup, and limiting the child’s consumption of juice to 4 to 6 oz per day. Serving 100-percent fruit juice or reconstituted juice.
• If the child drinks beverages between meals, encouraging the child to drink water or milk rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
• Drinking fluoridated water (via a community fluoridated water source) to prevent tooth decay; for families that prefer bottled water, drinking a brand in which fluoride is added at a concentration of approximately 0.7 to 1.2 mg/L (ppm) is recommended.