In reference to the recently published review article on oral health in children(1), I have the following comments:

The guidelines presented by the authors, are based primarily on the published policy documents of the American Academy of Pediatric Dentistry (AAPD)(2). The same guidelines may not be applicable to Indian situations. For example, the AAPD document has consistently referred to certain mode of bottle feeding as an important causative factor, and also while suggesting preventive interventions for early childhood caries. In USA, only 43% infants are breastfed at 6 months out of which only 14% are exclusively breastfed; only 23% are receiving breastfeeding at 12 months. Large majority of babies aged 6 months and beyond are bottle fed. In comparison, according to National Family Health Survey-3, the use of bottles with nipples is not common in India. Bottle feeding increases from 5 % under age two months to 18 % at age 9-11 months and declines at older ages. The median duration of breastfeeding is 24.4 months which means breastfeeding remains a predominant mode of feeding the infant and young children in India(3). As the situation of feeding practices is not comparable in both the countries, there is a need to address the guidelines in Indian context.

International and National policies on infant and young child feeding, including IAP’s policy, recommend exclusive breastfeeding for first six months of life followed by introduction of complementary foods after completion of 6 months of age and continued breastfeeding till 2 years or beyond. These policy documents also recommend breastfeeding on demand, day and night. However, Chandna, et al.(1) have given statements and recommendations which are not only contrary to these accepted norms of infant feeding but also without any robust research evidence. The article suggests that breastfeeding on demand is associated with development of early childhood caries and reference given for this observation is a review article published in 1998. The article further says that prolonged bottle or breast feeding provides an environment that enhances the development of early tooth decay. No specific reference has been cited for this statement.

Keeping the relevance of the optimal infant and young child feeding practices as an important tool in the fight against child morbidity and mortality, it is crucial to re-examine the facts cited in the article.