July | 2013 | Motherworldly

Breastfeeding and teeth

Dr Mark Porter on Radio 4’s Inside Health last week had an interesting piece where a particular type of dental problem in children was attributed to extended breastfeeding.

Molar incisor hypomineralisation is described by Professor Monty Duggal, Head of Paediatric Dentistry at the Leeds Dental Institute as “pain and sensitivity in their back molars and also unsightly marks on [children’s] upper front teeth.” This appears to be a relatively new phenomenon, occurring in the last 15 years, and reportedly affects up to 16% of children in the north of England.

Importantly, Professor Duggal explains that this is a perinatal event; that is, something that happens around birth. He then goes on to suggest that new Swedish studies show a link with extended breastfeeding without introduction of solids. He defines extended breastfeeding as breastfeeding beyond six months, which of course is outside the perinatal period.

This raises a few questions for me. We know that in the UK, 23% of babies are still breastfed at six months, but fewer than 2% are exclusively breastfed. Current Department of Health guidelines are to introduce solids at around six months, and the vast majority of parents do it before this time. So I was curious to know where a large enough sample of babies who were exclusively breastfed beyond six months could be found, which perhaps is possible in Sweden where breastfeeding rates are higher, but even so that’s hard to tie up with the stated 16% Molar-incisor hypomineralisation figure for the UK. The Professor’s recommendation to introduce some solids by six months is hardly ground-breaking, but my concern would be that “by six months” would make parents feel they need to start earlier than that, which is not supported by the Department of Health.

With no reference to the Swedish study, it has been hard to follow this up; but I have found an interesting webpage that collates 40 studies of Molar-incisor hypomineralisation from different countries. Without PubMed access, I can only read the abstracts, but few of them mention breastfeeding at all, and this one from 2008 explicitly finds no link with breastfeeding. A 2012 study co-authored by Duggal doesn’t mention breastfeeding in the abstract, but does find a link with lower socio-economic status. Which is interesting in that we also know lower socio-economic status is correlated with shorter duration of breastfeeding. These figures don’t stack up.

On the basis of this interview and my subsequent reading, I cannot see a basis for Duggal’s claim that “they’re nutritionally not fully supported” in the context of dental issues; however it is well-established that breastmilk is a nutritionally complete diet until around the age of six months, when complementary foods are usually needed.

Finally I discovered that Dr Mark Porter is heavily involved with baby milk manufacturer Cow & Gate. Some cynics might feel that such a vested interest in not breastfeeding should be declared whenever there is an article about breastfeeding on the show.

Book Review: BabyCalm – A guide for calmer babies & happier parents

This is a book absolutely loaded with practical information and advice, written by Sarah Ockwell-Smith, the founder of BabyCalm™. The focus of the book is extremely baby-centred, and the chapter on Understanding Your Baby’s Needs is excellent, with good clear explanations and examples to help the reader empathise with the baby and use this knowledge to find easy and gentle ways to parent.

I can identify with this position, and found myself nodding in agreement through paragraph after paragraph, particularly in the chapter about maternal instinct, which was disappointingly short, but was picked up again in a later chapter on the transition to motherhood.

There are a number of very practical sections, notably the excellent and highly accessible description of ‘babywearing;’ and although I have personal reservations about the use of that word as a verb, Ockwell-Smith does point out that it was coined by the revered Dr Sears, not by her. I would have no such reservations about using the book to show a client how to use a wrap sling, and found it more helpful than the various YouTube videos I have looked at in the past. Similarly the baby massage instructions are clear and easy to follow.

Acknowledging that sleep is a major issue for many new parents, three of the twelve chapters are given over to helping parents to manage it, and her description of normal baby sleep and the mismatch of new parents’ expectations is very clear and useful, and there are some good tips in her ten ways to encourage more sleep at night.

The section on breastfeeding is well based within the evidence about how breastfeeding works, with the exception of the paragraphs about lactose intolerance, which are both confused and confusing. (Symptoms of both cow’s milk protein allergy, and lactose intolerance are given, followed by a personal anecdote describing the symptoms attributed to CMP allergy, but which were apparently resolved by giving lactose-free formula. The chapter was absolutely adequate without the anecdote). Most of the book is applicable to formula feeding mothers, but I am not sure that this is made quite clear enough.

The book is very well-referenced, although in places it is not clear how the studies quoted support the point being made. I was concerned that the single study quoted in support of chiropractic treatment was written by an enthusiastic chiropractor, and may not have been entirely free of bias. The discussion of chiropractic should cover the potential risks, just as the section on dummies does. Ockwell-Smith plunders the related literature and also packs the text with real stories from mothers who give examples of how BabyCalm™ has helped them. For me there was a little bit too much in the way of anecdote, but perhaps that’s because I’ve read so many of these books, and they may well trigger lightbulb moments for new parents trying to find their place in their new worlds. Stylistically, I did not enjoy the first person voice and felt that Ockwell-Smith shares too much of her own experience, which could possibly come across as a little more directive than is intended.

I enjoyed reading BabyCalm and it helped me to reflect on how I talk to new and expectant parents, particularly about advice and instinct. I would be more likely to recommend it to people who I know to be inclined towards attachment parenting, as I don’t think it has universal appeal, but it’s definitely one I’m happy to have in my library.

[Disclosure: I was sent a free copy of this book by publisher Piatkus]