Sunday, March 23, 2014

Breastfeeding Past Two Years Linked to Infant Tooth Decay

By Kathleen Raven
March 17, 2014
NEW YORK (Reuters Health) - Breastfeeding is credited with a long list of benefits, but one downside of extended and intensive breastfeeding may be a higher risk of cavities in baby's first teeth, according to a new study.
The more frequently a mother breastfed her child beyond the age of 24 months during the day, the greater the child's risk of severe early tooth decay, researchers found.
Benjamin Chaffee of the University of California, San Francisco led the study as a doctoral student at the University of California at Berkeley. He and his team looked at a possible link between longer-term breastfeeding and the risk of tooth decay and cavities in a survey of 458 babies in low-income families in the city of Porto Alegre, Brazil.
Because the study lasted more than one year, most babies were consuming various kinds of solid food and liquids in addition to breast milk.
The World Health Organization (WHO) recommends that babies are fed breast milk exclusively for the first six months of their lives, with solid foods added to the diet at that point. However, the WHO also recommends continued breastfeeding up to age two and beyond, the authors note.
For the study, the researchers checked in on babies when they were about six, 12 and 38 months old. At six months, the study team gathered data on the number of breast milk bottles the baby drank the day before and any other liquids, like juice.
At the 12-month mark, parents reported whether they fed their babies any of 29 specific foods, including fruits, vegetables, beans, organ meat, candy chips, chocolate milk, cookies, honey, soft drinks or sweet biscuits.
Two trained dentists examined all of the babies at each of the visits.
Nearly half of the children had consumed a prepared infant formula drink by age six months, the researchers reported February 19 online in the Annals of Epidemiology, but very few still drank formula by age one.
The researchers found that about 40% of children who were breastfed between ages six and 24 months had some tooth decay by the end of the study. For babies breastfed for longer than two years and frequently, that number rose to 48%.
"Our study does not suggest that breastfeeding causes caries," Chaffee told Reuters Health.
It is possible that breast milk in conjunction with excess refined sugar in modern foods may be contributing to the greater tooth decay seen in babies breastfed the longest and most often, the authors speculate in their report.
More research is needed to determine what's going on, but the findings are in keeping with professional dental guidelines that suggest avoiding on-demand breastfeeding after tooth eruption, they write.
"There are two aspects of breastfeeding - the actual human milk, which has some, but very little, ability to promote tooth decay," said William Bowen, professor emeritus in the Center for Oral Biology at the University of Rochester Medical Center in New York.
"The second is the physical aspect of breastfeeding, or even bottle-feeding, and that's where the problem arrives," he said.
Bowen was not involved in the new study.
When a baby sucks on a mother's breast or from a bottle, the baby's teeth are sealed off from saliva in the mouth. This physical barrier prevents the saliva from breaking down bacteria, and increases the chances of tooth decay, Bowen said.
Even though participants in the study came from poor backgrounds, "bad habits can form at any socioeconomic level," Bowen told Reuters Health.
About 16% of babies in the U.S. were still exclusively breastfed at age six months last year, according to the National Center for Chronic Disease Prevention and Health Promotion.
The good news, Bowen said, is that it's very easy to clean an infant's teeth.
A simple wipe in the mouth with a water-dampened cloth or Q-tip can effectively remove food before the baby's first teeth, he said, adding: "It's important to get the excess food out of the mouth."
One not-so-good habit is allowing infants to stay on a mother's nipple throughout the night, Bowen said. This usually means very little saliva circulates in the baby's mouth, which can increase the risk of decay.
The primary caregiver of the baby should also maintain good dental health because the bacteria that cause tooth decay in a baby usually come from the primary caregiver, Bowen explained.
The American Academy of Pediatric Dentistry recommends that parents take their child for a first dental visit when the first tooth appears, or no later than the first birthday.
Brushing teeth might help, Chaffee said, The study researchers collected data on tooth brushing habits, but did not investigate a specific link between cleaning teeth after the last feeding and caries.
"But anything that removes carbohydrates and sugars from the oral cavity should help prevent too decay," Chaffee said.
Ann Epidemiol 2014.

Limit Food Allergy Panels, AAP Says in Choosing Wisely List

Larry Hand
March 18, 2014

The American Academy of Pediatrics (AAP) has released its second list of common tests and treatments to question as part of the Choosing Wisely initiative.
The AAP also announced on March 17 the launch of an online learning module pediatricians can use to help with 2 items on its first Choosing Wisely list, released in February 2013. The module is designed to avoid use of antibiotics for viral respiratory illnesses and the use of unnecessary computed tomography scans.
"The AAP strongly supports partnerships and tools that improve the quality of care for patients," AAP President James M. Perrin, MD, said in a news release. "Pediatricians want the best possible tests and treatments for their patients, and they want them to be used appropriately. This is particularly important when treating children, because they are still growing and developing."
The new evidence-based recommendations are:
  • "Don't prescribe high-dose dexamethasone (0.5mg/kg per day) for the prevention or treatment of bronchopulmonary dysplasia in the pre-term infant.
  • Don't perform screening panels for food allergies without previous consideration of medical history.
  • Avoid using acid blockers and motility agents such as metoclopramide (generic) for physiologic gastroesophageal reflux...that is effortless, painless, and not affecting growth. Do not use medication in the so-called 'happy-spitter.'
  • Avoid the use of surveillance cultures for the screening and treatment of asymptomatic bacteruria.
  • Infant home apnea monitors should not be routinely used to prevent Sudden Infant Death Syndrome."
The AAP's complete list of Choosing Wisely recommendations is available online. The first 5 recommendations are:
  • "Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).
  • Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children under four years of age.
  • Computed tomography (CT) scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is indicated.
  • Neuroimaging (CT, [magnetic resonance imaging]) is not necessary in a child with simple febrile seizure.
  • [CT] scans are not necessary in the routine evaluation of abdominal pain."
Choosing Wisely was launched in 2012 by the American Board of Internal Medicine. A national campaign, Choosing Wisely involves more than 50 medical specialty societies identifying common medical tests and treatments that may not be necessary or of benefit to patients.

Supplement May Reduce Diarrhea Burden in Preschoolers

Larry Hand
March 17, 2014
Daily doses of live bacterial supplementation may reduce the occurrence and duration of diarrhea and respiratory tract infection (RTI) in preschool children, as well as lower the costs of treatment, according to a study published online March 17 inPediatrics.
Pedro Gutierrez-Castrellon, MD, DSc, from the National Perinatology Institute, Mexico City, Mexico, and colleagues conducted a randomized, double-blind, placebo-controlled trial at 4 day care centers near the institute between April 2011 and June 2012.
A computer-generated randomization placed 336 healthy children aged 6 to 36 months who were born at term (≥36 weeks' gestation) and who had similar socioeconomic characteristics in 2 equal-number groups. Half the children (168) received Lactobacillus reuteri DSM 17938 (1 × 108 colony-forming unit) and half (168) received placebo once a day for 12 weeks. All of the children completed the study with no breached protocols, the researchers report.
Parents gave the dropper doses on first feedings in the morning, and researchers assessed compliance on the basis of empty bottles returned and parent-kept diaries. Researchers instructed parents on how to monitor daily the stool consistency of their children and to report any respiratory symptoms. Confirmed RTI cases led to hospitalized or outpatient care.
L reuteri supplementation helped reduce the number of days with diarrhea per child from 0.96 (0.2) to 0.32 (0.1; P = .03) during the trial and from 1.1 to 0.5 (P = .01) during a 12-week follow-up period.
In addition, the researchers report that 99 episodes of diarrhea occurred among the L reuteri group compared with 152 episodes among the placebo group (P = .01). Diarrhea lasted an average of 1.6 ± 0.9 days in the L reuteri group and 2.7 ± 1.1 days in the placebo group (P = .02).
L reuteri supplementation helped reduce the number of days with RTI per child from 4.6 (1.8) to 1.5 (0.6; P = .01) during the trial and from 4.4 (1.1) to 2.1 (0.8; P = .01) during follow-up.
L reuteri supplementation also helped significantly reduce the number of days of school absences (P = .03), the number of healthcare visits (P = .04), and the number of days of antibiotic use (P = .04) during the trial and in follow-up. In a cost–benefit analysis, the first such analysis they are aware of, the researchers found that L reuteri supplementation also helped reduce healthcare costs.
"The prophylactic use of L reuteri was associated with a reduction of $36 US dollars (USD) for each case of diarrhea and $37 USD for each case of RTI," the researchers write. They calculated the incremental cost effectiveness ratio at −35.7 for diarrhea and −37.4 for RTI.
"This study adds independent support to previously published evidence that can now be used in systematic reviews to establish evidence-based recommendations for the use of L reuteri DSM 17938 in the prevention of infectious diseases in day care Centers," the researchers conclude.
This research was supported by GioGaia AB, Stockholm, Sweden, who supplied the L reuteri and placebo products used in the trial. The authors have disclosed no relevant financial relationships.
Pediatrics. Published online March 17, 2014. Abstract