where weight gain is paramount and the dental implications are secondary, if indeed
they are even considered. Drinks can also be a difficult area, particularly the use of
sweetened bottles for an extended period in a child's life. It is not uncommon for
children of 2 years of age or older still to be using a bottle containing milk, often for
naps, last thing at night before going to bed and even during the night. This is an
extremely difficult habit to break, but the most successful approach has been to advise
the parent gradually to dilute the contents with water over a period of weeks, until
eventually the child is drinking water only. This not only eliminates the undesirable
habit but also gives the parent of the child, who is able to be toilet trained, some
prospect of getting the child dry and out of nappies overnight.
For a number of children with impairments, the use of sweetened medication has led
to an increase in dental caries (1142HFig. 17.14). In the past this has arisen because of a
lack of sugars-free alternatives. However, with the pharmaceutical industry's greater
awareness it is often only due to ignorance among the medical profession that such
outmoded prescribing continues. Some children will be taking medication as
dispersible tablets or in an effervescent form, some of which, with chronic use, may
predispose to dental erosion.
Another consideration is spoiling. For any parent the birth of a child who is impaired
in some way, is a shock. Months of eager anticipation are followed by disbelief,
anger, denial, frustration, and guilt. Parents have to grieve for the normal child they
will never have, before coming to terms with their new responsibilities. Parents
continue to feel guilty; maybe their child has an impairment because of something
they have done, or something they should not have done. Either way, they may
attempt to assuage that guilt by spoiling the child. This may take the form of easy to
eat sweet foods, which are thought to be pleasurable and are welcomed by the child
with a poor appetite, thus compounding the problem of poor eating. Poor eating habits
resulting in oral disease need to be tackled together with the paediatrician and
dietician, as well as the parents or caregivers.
Key Points
General dietary advice:
- Restrict sweet foods/drinks to mealtimes.
- Limit sweetened foods/drinks to three times a day.
- Keep food and drinks clear of bedtime by about an hour.
- Remember that carbonated drinks, and some medicines are erosive to teeth.
- Ask for sugars-free medicines.
Fluorides
Many special milk formulas and food supplements, as well as containing non-milk
extrinsic sugars to boost the child's calorie intake, in some cases also have quite
substantial amounts of fluoride. It is wise therefore to check the diet carefully before
advocating the use of fluoride supplements for such children. Where dental caries is
potentially a real problem and in the absence of any other form of systemic fluorides,
then the daily fluoride supplement regimen of 0.25 mg from 6 months of age,
followed by an increase to 0.5 mg at 3 years of age, and then 1.0 mg from 6 to 16
years of age is to be advocated. Once the concentration of fluoride in the local water
supply is known from the water company, fluoride supplements can be prescribed by