Do you need to night wean to prevent cavities?
It’s a common question. A one-year-old wakes a few times a night to breastfeed. Perhaps this one-year-old has teeth. Should they stop night feedings? More specifically, is a baby’s dental health a reason to night wean? Many parents and babies aren’t ready to stop nighttime feeds, but may wonder about cavities, also called dental caries. Today’s post discusses one approach to preventing tooth decay without night weaning.
This is for parents of babies who wake to breastfeed overnight. Sometimes, a baby’s health care professional will recommend night weaning in order to protect a baby’s teeth. (If you are reading this, please follow all medical advice of the team actually seeing you and your baby).
Here’s the brief overview of one way to continue breastfeeding at night without risking dental decay: Brush teeth well with fluoride toothpaste after the baby’s last solid meal. For the rest of the night offer only breast milk or water. Brush the child’s teeth again in the morning.
These aren’t official guidelines. There is evidence, science, and logic, however. The rest of this post explains the reasoning and details, as well as linked references. I’d like to think it can be a useful starting point to discuss with a child’s dentist or pediatrician.
“The dentist told me to stop breastfeeding at night.”
Let’s quickly go over the rationale behind this recommendation to stop nighttime feedings. Tooth decay comes from bacteria in the mouth in addition to sugar. When someone snacks frequently on sugar, it coats their teeth. The bacteria thrive and cavities result. So, it makes sense that a baby eating through the night would have a greater risk for cavities. There is also less saliva at night. Saliva normally helps protect the teeth, so nighttime is riskier in general. This is why we should all brush our teeth before going to bed.
For more details on dental care for babies, including toothbrushing, and why this matters for both the first tooth and permanent teeth alike, please see my last post.
However, breast milk is a bit different. Breast milk alone does not harm teeth. See the next section.
For formula fed babies, this is important. Some infant formulas can cause cavities if the teeth aren’t cleaned. Also, when a baby drinks from a bottle, the liquid comes in contact with the teeth. The infant formula can pool behind the front teeth. If the bottle contains formula (or other sugary liquids, like juice), prolonged contact causes tooth decay. Some call this “baby bottle tooth decay” or “bottle caries.” For reference, if a baby is feeding directly at the breast, the nipple goes further back in the baby’s mouth. The milk does not necessarily pool around the baby’s teeth. It’s swallowed more directly.
As we’ll see in the next section, when it comes to teeth, there are a few other differences between formula and breastmilk.
A few notes on breastmilk and baby teeth
Firstly, breastmilk alone does not cause cavities. In fact, breastfeeding up to age 12 months actually protects against tooth decay. There are many studies that show this. See here (from dentist Dr. Brian Palmer), here and here for more proof. It’s an important thing to remember. It’s also kind of amazing.
The research is less clear after 12 months of age, likely due to how difficult it is to study. It’s hard to account for all the the different risk factors like diet, dental hygiene, and environment.
We also need to remember that breastfed babies can still experience tooth decay. They’re not immune from childhood cavities. In fact, breastmilk in addition to another source of sugar can increase risk for early childhood caries. So, if a child has been eating cookies, then has breastmilk (without cleaning their teeth beforehand), their risk for cavities is higher. However, breastmilk alone does not cause dental problems in healthy teeth.
Toothbrushing is still important.
When considering all that affects a child’s teeth, there’s one we have a lot of control over: brushing with toothpaste. Good dental hygiene goes a long way. Cleaning well and using fluoridated toothpaste is important for oral health.
So, if breastmilk alone is protective, is night weaning necessary?
Personally, I don’t think night weaning is always needed. I have yet to find good extensive research on breastfeeding at night specifically and its relationship to tooth decay if teeth are brushed at bedtime. (If you have some, please share. I’ll update and edit this post). In the meantime, we can draw some conclusions ourselves. Based on what we know, here is one approach for families who are not ready to night wean and still want to keep their child’s teeth healthy.
- Brush teeth twice a day with fluoridate toothpaste & see a dentist regularly (see my other post for details).
- For the nighttime brushing, brush after the last solid meal.
- In the evening, after teeth have been brushed, offer strictly only breastmilk or water. Sippy cups are a great option for drinking water. No snacks, vitamins, medications, or other drinks.
Consider modification for children over age 18-24 months.
Although the evidence isn’t great across many studies, a 2017 paper found increased risk for childhood cavities in children breastfed longer than 2 years. And, a more recent study found associations with cavities for children who breastfed at night longer than age 18 months. We cannot ignore this. With that in mind, it may be worthwhile to brush teeth after breastfeeding children over age 18-24 months. As mentioned earlier, there are also many more variables as babies get older.
The composition of breastmilk doesn’t change a lot from 12 to 18 months. But, lifestyle and babies do change. They snack more. They may be more resistant to tooth brushing. And, they may eat a wider variety of foods, including foods with added sugar. In a research setting, these other variables can be hard to account for.
A quick thought on night weaning in general
Every family is different, and some babies start to sleep through the night on their own before age one. This is fine, of course. That being said, if everything is going really well for a family and there are no complaints, I don’t usually recommend a family try to intentionally night wean before age 12 months. This is strictly for reasons of baby’s health and a parent’s milk supply. (Milk supply is a separate topic. This is just a general comment for context).
Of course there are so very many other factors involved in parenting at night. If there are any concerns for the parent or baby (including sleep, mental health, growth, and yes, teeth) this very general recommendation goes out the window. Please discuss with your individual healthcare team. I mention here for someone just trying to get a ballpark idea of timing.
Again, breastmilk until age 12 months protects the teeth against cavities and decay. So, there are a few reasons to not night wean before age 1 if you don’t want to.
Summary: When it comes to night weaning, do what’s best for your family.
This is a topic of ongoing research. However, if a baby or child has thorough toothbrushing before bedtime and drinks only water or breastmilk afterwards, they may not increase their risk for cavities. After age 18 months or so, it might be reasonable to consider decreasing nighttime feeds or cleaning teeth after each feeding. This is based only on available research and not necessarily a specific change in a toddler’s mouth.
Again, these are not formal guidelines. However, I know that night weaning at age 12 months isn’t practical for every family. This is one approach to minimize risks of tooth decay while still breastfeeding at night. It’s also a reminder that even babies under age 12 months still need excellent toothbrushing before going to bed.
Both the American Academy of Pediatrics (AAP) and the World Health Organization (WHO) recommend breastfeeding for at least the first year of life when possible. Breast milk covers the nutritional needs of babies during a baby’s first four to six months. It continues to provide excellent nutrients and calories beyond those early months, even after solids are introduced. So, we should do all that we can to help support breastfeeding parents whatever time of day it is. I hope this information is helpful for expectant parents, new moms, and healthcare professionals alike. If we take a few extra steps, we can see that there are many different solutions to parenting –and feeding– at night.
I welcome feedback! Please feel free to contact me or leave a comment below. I’m happy to update this post as we all learn more.
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Maya M. Mahmood, D.O., FAAP is a board-certified pediatrician and mom. She is passionate about parents having evidence-based information to help their families be healthier.
Disclaimer:
Content on this site and from MayaPeds LLC is for information only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your baby’s health. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
