Anticipatory Guidance (continued)

Nutrition

• Breastfeeding the infant exclusively for approximately the first 6 months of life and continuing to breastfeed until age 12 months or as long as the mother and infant wish to continue.
• For mothers who cannot breastfeed or choose not to breastfeed, feeding the infant a prepared infant formula. No additional nutrients are needed.
• Avoiding testing the temperature of the bottle with the mouth, 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.
• Not putting the infant 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 infant’s risk for tooth decay.
• Holding the infant while feeding. Making sure to never prop a bottle (that is, use pillows or any other objects to hold a bottle in the infant’s mouth).
• Never adding cereal to a bottle. This causes sugary fluids to pool around the teeth. Feeding the infant solid foods with a spoon or fork, or, once the infant is able, encouraging self-feeding.
• Introducing a small cup when the infant can sit up without support.
• Weaning the infant from the bottle as the infant begins to eat more solid foods and drink from a cup. Beginning to wean the infant gradually, at about age 9 to 10 months. By age 12 to 14 months, most infants can drink from a cup.
• Not introducing juice into infants’ diets before age 6 months. Serving the infant juice in a cup, and limiting juice to 4 to 6 oz per day. Serving 100-percent fruit juice or reconstituted juice.
• For infants ages 6 months and older, serving age-appropriate healthy foods during planned meals and snacks, and limiting eating (grazing) in between.
• 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.
• 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.