Key Dietary Messages

Transcription

1 Key Dietary Messages Developed by Dr. Teresa Marshall, Ph.D Department of Preventive and Community Dentistry College of Dentistry, University of Iowa Dietary Behavior Number of meals/s Meal patterns Between-meal/ beverages Goal Sufficient Optimal < 6m: on demand < 6m: on demand 6 m-1 year: move towards 3 meals with 3 s > 1 year: 3 meals and 3 s No eating or drinking sweetened beverages between meals and s > 6 m: water or other sugar-free beverage 6 m-1 year: move towards 3 meals with 3 s > 1 year: 3 meals and 3 s Structured meals and/or s of < 30 minutes at the same time each day 6 m-3 y: water > 3 y: water or other sugar-free beverage Rationale 1) During early infancy, on demand feeding encourages bonding and food security; stomach is too small to hold sufficient formula/feeding for structured meals. 2) Beyond infancy, 3 meals and 3 s are frequent enough to assure food security and adequate intake for growth. Structured, defined meals/s limit oral exposures. They also provide food security and minimize food battles between child and caregiver. Encourages development of healthy eating patterns. 1) During early infancy (< 6 m), infants should receive infant formula or human milk on demand; intake should not be compromised with either sugar-free or sugared beverages except during extreme heat when water might be appropriate. 2) Between 6 m and 3 y, the optimal beverage for hydration is water. Although sugar-free beverages are not harmful, neither are they beneficial and are best avoided. After 3 y, with peer pressure, sugar-free beverages are a better between meal alternative than sugared beverages. 3) Providing sugared beverages between meals a) increases caries risk and b) blunts appetite, making child less receptive to more healthy foods at meals/s and encouraging food refusal and poor eating patterns.

2 Infant formula < 6 m: on demand < 6 m: on demand 6 m-2 y: with meals/s 6 m-1 y: with meals/s 1) Infant formula is appropriate beverage to meet nutrient requirements at this age. 2) During early infancy, on demand feeding encourages bonding and food security; stomach is too small to hold sufficient formula/feeding for structured meals. Milk 100% juice Soda-pop (sugared) Other sugared beverages (i.e., juice drinks, Kool-Aide, sports drinks Sleeping with bottle/breast Nighttime feedings < 1y: none < 1y: none > 1 y: 4-8 oz/serving > 1 y: 4-8 oz/serving with meals/s with meals/s < 6 m: none < 6 m: none 6 m-6 y: < 8 oz (i.e., 1 c or 1 juice box) with a meal or 6 m-1 y: < 4 oz with 1-6 y: < 6 oz with < 3 y: none < 3 y: none 2-6 y: < 8 oz with 3 y: special occasion only; limit to 8 oz < 3 y: none < 3 y: none 2-6 y: < 8 oz with 3 y: special occasion only; limit to 8 oz > 6 m: provide water only 1) Milk is choice beverage for adequate nutrient intake to support growth at these ages. 2) Consumption at meal to decrease caries risk and limit effects on appetite. 1) Volume recommendations in accordance with American Academy of Pediatrics too much juice replaces more nutritious foods and beverages and increases potential for malnutrition/poor growth. 2) Consumption at meal/ to decrease caries risk and limit effects on appetite. Can be offered at end of meal/ to encourage eating solid foods. 1) Sugared soda-pop has no nutritional value replaces more nutritious foods and beverages and increases potential for malnutrition/poor growth. 2) Consumption between meals/s increases caries risk and blunts appetite. 1) Sugared soda-pop has no nutritional value replaces more nutritious foods and beverages and increases potential for malnutrition/poor growth. 2) Consumption between meals/s increases caries risk and blunts appetite. Discontinue Discontinue Providing on-demand nighttime feedings increases caries risk and distorts normal feeding behaviors. <6 m: on demand <4 m: on demand 1) During early infancy, on demand feeding encourages bonding and food security; stomach is too small to hold > 6 m: provide water only 4-6 m: wean from behavior sufficient formula/feeding for structured meals. 2) After early infancy, nighttime feedings increases caries risk and distorts normal feeding behaviors.

3 Bottle, sippy cup use 1) The child should be transitioned from bottle to cup feedings when the child reaches a developmental age of about 1 y and can consume sufficient liquids by cup to ensure adequate hydration. 2) Sippy cups can be used throughout the day they are merely the vehicle to deliver the liquid. Sippy cups can contain formula, milk, 100% juice or sugared beverages at meals and s, but should only contain water or other sugar-free beverages between meals/s. Notes: 1) Children refusing milk require calcium and vitamin D supplementation. 2) As children move from formula to solid foods, basic foods should be introduced. By 2 years of age, the diet should be consistent with MyPyramid. 3) Iron status needs to be monitored following transition from infant formula to cow s milk. If meat or other iron-fortified foods are not consumed, iron deficiency is a potential risk. Iron deficiency anemia during early childhood is a leading cause of mental retardation in the United States, particularly among low-income children, and is easily prevented. 4) All references to water in the above table refer to tap or plain water. Flavored/carbonated waters with sugar sweeteners (i.e., honey, sucrose, or high fructose corn syrup) should be considered as other sugared beverages, while flavored/carbonated waters without sweeter or with an artificial sweetener (i.e., nutrasweet, acesulfame K) should be considered as other sugarfree beverages.

4 Key Oral Hygiene Messages Developed by Dr. Karin Weber-Gasparoni, DDS, MS, Ph.D Department of Pediatric Dentistry College of Dentistry, University of Iowa Oral Hygiene Behavior Goal Rationale When to use wet washcloth to clean teeth Before tooth eruption: clean gums and tongue with wet washcloth either at bedtime or at bath time Cleaning the baby s mouth before tooth eruption either at bedtime or bath time helps the child to get used to the adult/parent manipulating his/her mouth, but most importantly it helps the adult/parent to establish a daily oral hygiene routine in their schedule that will be crucial after the eruption of the child s teeth When to introduce toothbrushing When to introduce fluoridated toothpaste Amount of fluoridated toothpaste After eruption of lower and upper front teeth: best to brush with toothbrush Begin brushing with fluoridated toothpaste after the first tooth is fully erupted Pea-Sized Amount After eruption of the lower and upper front teeth, it is best to start brushing the child s teeth with a toothbrush rather than a wet washcloth. The washcloth will not clean and remove plaque from teeth as well as the toothbrush. Most of children s toothbrushes have soft bristles that will not hurt the child s gums and other oral structures Small amounts of fluoride from the toothpaste on a daily basis is the most effective way to prevent caries, especially for high-caries risk children Young children can t spit most the toothpaste used and may swallow some of it. So, the key is the amount. A smear amount is the ideal amount for children 6 to 24 months; a ½ pea-sized amount for children 24 to 36 months of age, and a pea-sized amount for children older than 3 years of age

5 Time to brush children s teeth Who should brush children s teeth Brushing during nighttime bottle- and breastfeeding How to brush the teeth of uncooperative children The more times teeth are brushed during the day, of course, the better it is. However, the most important time is right before bedtime Toothbrushing in the morning and before bedtime is ideal An adult should brush the child s teeth until the child is in 1 st or 2 nd grade After the child is in 1 st and 2 nd grade, adults should supervise the toothbrushing Brush before bedtime feeding and first thing in the morning after any nighttime feeding During toothbrushing, distract the child: sing, tell a story, watch a movie, play a game Brushing teeth before bedtime is extremely important since there is a significant reduction of salivary flow during sleeping hours. The chemical and physical properties of saliva help to fight off bacteria that cause cavities Brushing twice a day increases the likelihood that plaque will be better removed from teeth rather than only once a day. However, if brushing will occur only once a day, the best time is right before bedtime It is not until children are 6 to 7 years of age that they have the necessary motor skills to brush their teeth effectively Adults should motivate children < than 6- to 7-year-old to learn how to brush their own teeth. Making a deal during brushing between the child and the adult is a good way to form a great partnership and guarantee that the child will have fun and learn how to brush his/her teeth, but also guarantee that the adult will be the one responsible for cleaning the child s teeth One tip: place the fluoridated toothpaste on the toothbrush only when it is the time for the adult to brush the child s teeth When mothers are willing to breastfeed on-demand and/or the child is being bottlefed to sleep or in the middle of the night, the best is to educate them about the caries risk of nighttime feeding. But also to educate them of the importance of toothbrushing with fluoridated toothpaste right before the bedtime feeding and brushing the child s teeth first thing in the morning after any nighttime feeding. It will not completely decrease the risk for caries, but it may help in the remineralization of teeth with the fluoridated toothpaste and guarantee that feeding will occur most likely in an environment free of plaque The problem of toothbrushing with children is the restrain necessary during brushing and the desire to be independent and do things by themselves. In terms of the sense of independence, establish the partnership

6 How to position young children to brush their teeth Establish a partnership between the child and the adult Be creative and consistent with toothbrushing day after day Make it comfortable for the child and effective for the adult to brush between the adult and the child as discussed above. In terms of the restrain, try to make brushing fun by distracting the child with songs, games, movies, cartoons, etc. Advise the adult/parent to be creative during brushing and find out what works best for the child and, very importantly, to be consistent with brushing day after day Adults need to restrain the child s body and head movements during toothbrushing. Advise them to be creative and gentle One tip: Lift the child s lip during brushing to brush the upper front teeth better and pull the cheeks away to better brush the outside (buccal) surfaces of the back upper and lower teeth