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Monday, July 28, 2014
When to Stop Bottle Feeding (and Sippy Cups)
My granddaughter is nearly 5 and her parents continue to give her bottles of milk at nap and bedtimes because she wants them. She also drinks water and juices at meals and throughout the day from sippy cups (never a regular cup unless I give it to her). I am concerned about her dental and emotional health. Will she end up needing braces? Is there potential for other problems? She has a 3 yr old sister who is on the same path.
It is not so much a problem of causing or worsening dental malocclusion as it is a risk for promoting dental caries, also called cavities. Because she will soon begin the process of shedding her primary or baby teeth and cutting her permanent teeth meant to last a lifetime (that would be about 85+ more years for her), this is an important time to stop the consistent bathing of her teeth with juice and milk sugars from bottles and sippy cups.
As long as one child will be going through the elimination of sippy cups and bottles, the other child should as well. The three year-old is past due to stop bottle and sippy cup use too. The children should each have an alternate security object just as a favorite blanket, doll or stuffed animal for comfort.
I recommend creating a storybook with pictures of each girl taking care of her teeth so that she will not have ugly brown teeth with fillings and holes in them (they could draw pictures of ugly teeth to be used in their book). Protective things include brushing their teeth twice each day, throwing away bottles and sippy cups because they are big girls who know what to do, drinking from cups without tops and glasses, eating healthy foods, and visiting the dentist twice each year. Take the children's pictures doing all of the right things and create a simple story about how Jo and Jenny (make believe names) Protect Their Teeth. When the storybook is complete, read it together with the girls and then have them proudly throw away all of their bottles and sippy cups. Celebrate their smart behavior by giving each girl a special badge or sticker to wear. Then don't look back. No giving in to pleas.
The adults should remain calm and acknowledge that it is sometimes hard to do the big girl thing to take care of their teeth, but don't give in. Even once giving in for one girl will set the whole thing back. Inconsistent reinforcement of behavior (like giving in sometimes to pleas) makes the behavior all the more difficult to break.
As long as the children have a security object or two at hand to help during stressful times, they should be just fine psychologically. Allowing them to persist in babyish behaviors that will lead to decayed and ugly teeth sets them up for ridicule by other children, which does harm self-esteem.
All this said it may still be a tough thing to resist the pleas, crying and tantrums that may come with this decision. Ideally, their parents will be on board with this. Otherwise, you can simply make the rule that at your home, big girl glasses are used and never any sippy cups or bottles. Perhaps if parents see the girls really can let go of these baby behaviors, they will follow along with the plan. Over many years I have learned that parents often do harmful things but with good intentions. So letting the girls have the cups and bottles may avoid the stress of tears and tantrums and offer each girl a familiar routine that promotes sleep. However, once parents know the down side to this (teasing by other children and dental pain and costly treatment), they are often able to see that enduring short term protest is worth the benefits of healthy teeth for a lifetime.
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University