Question:
My 25-month-old daughter has developed tooth decay and will need some major dental work done. I have seen three pediatric dentists and every single one of them says that the cause is from night nursing and that we need to wean her immediately. Even our La Leche League Leader has recommended that we wean from night nursing. We share a family bed and she wakes three to eight times a night to nurse (depending on teething, etc.). She rarely drinks juice or has candy and has never had a bottle. She drinks bottled fluoridated water and we have been brushing her teeth regularly. She did have a very bad mouth infection just before the decay set in. Before that, her teeth looked great. The decay has happened so rapidly that I find it hard to believe all these dentists telling me the infection had nothing to do with it and basically, it's all my fault. Is it really possible that night nursing can cause tooth decay (especially teeth going from looking great to severely chipped and obviously decayed -- and needing to be removed -- in a matter of about six to eight weeks)? If I should wean from night nursing, what are some ways to do this while sharing the family bed?

Answer:
Yes, night nursing can cause tooth decay. For years, pediatricians and pediatric dentists have noticed a condition called nursing bottle carries, meaning tooth decay caused by nighttime bottles of juice or formula. The reason for this is when an infant falls asleep the natural rinsing action of the saliva lessens, which allows the sugary formula and juice to settle on the teeth, thus causing decay. The incidence of nursing carries is certainly much less in breastfed infants, but it does happen. After all, breastmilk is a very sweet and naturally sugary substance. There are several schools of thought on the severity of the problem of night nursing and tooth decay. The La Leche League tends to underemphasize this occurrence. Pediatric dentists tend to overemphasize the frequency and severity of this correlation since, after all, dentists only see the children in whom nursing carries occur, yet don't see the millions of infants who night nurse and don't get tooth decay. In fact, breastfeeding contributes to overall dental health by improving jaw alignment. Pediatric dentists often refer to breastfed babies as "having a nicer smile."

My position on night nursing causing carries is somewhere between La Leche League and pediatric dentists. Yes, it does occur and it is a problem that needs to be more readily addressed. However, it certainly does not occur to the extent that infants should not be night nursed after age 1, as some pediatric dentists recommend. Certainly at 25 months your baby could be night weaned, yet that is your personal decision. If you feel that your infant still needs to nurse to sleep, here are some alternatives, in addition to the good dental care you are already providing:

Brush your infant's teeth thoroughly as soon as she awakens in the morning or after the first nursing. Then, brush them several times during the day. If you use a fluoride toothpaste, be sure to use no more than a pea-sized dab, since toddlers swallow toothpaste and an overdose of fluoride can itself weaken the teeth.

Depending on the severity of the tooth decay, you might consider night weaning from the breast. Remember, "nursing" implies comforting and not just breastfeeding. There are many other ways of night "nursing" other than breastfeeding. You and your infant are obviously very attached and your infant is lucky to have you as her mother. Try not to blame yourself for your daughter's tooth decay, since the lifelong benefits of your milk far outweigh the effects of the temporary tooth decay.

While it's easy for your dentist to advise you to night wean, it is easier said than done. Yet, if you choose to night wean, here are some tips:

• Increase the distance between you and your infant at night. Try a side-car arrangement: a crib next to your bed. If your baby sleeps only inches away from her favorite cuisine and mom's all-night diner is open and available, naturally she's going to want to nurse. Putting a distance between baby and mom should get you a few extra hours of sleep.
• Honor your husband with his share of nighttime parenting. As we discussed above, nursing does not only imply breastfeeding. Fathers can "nurse," too, by rocking, singing and simply patting your baby when she wakes up.
• Just say no. Attachment-parenting mothers, in their zeal to take perfect care of their babies, often forget to take care of themselves. If you are burning out from night nursing, it's time to say no. A parenting principle we learned many kids ago is: If you resent it, change it. If you dread going to bed because it's work rather than rest, take this as your body's signal that you need to make a change. At 25 months your daughter is verbal enough to understand: "We only nurse when Mr. Sun comes up and when Mr. Sun goes down, 'Nummies' (or whatever she calls 'her breasts') go night-night." Mention that phrase to her when she goes off to sleep and as soon as she wakes up, so she is conditioned to truly believe that nummies go night-night.
• Move to another room. If all else fails and you are becoming exhausted because of night nursing, you sleep in another room for a couple of nights and let your toddler sleep next to dad. (Do this on a weekend night when your husband doesn't have to work the next day). Sleeping with dad teaches your baby that she can truly go through the night without breastfeeding.