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.
References
1. Chandna P, Adlakha VK. Oral health in children:
guidelines for pediatricians. Indian Pediatr 2010; 47: 323-327.
2. Policy of Early childhood caries (ECC):
Classification, Consequence and Preventive Strategies. Available from URL:
http://www.aapd.org/media/Policies_Guidelines/P_ECCClassifications.pdf.
Accessed May 26, 2010.
3. International Institute of Population Sciences (IIPS)
and Macro International. National Family Health Survey (NFHS-3), 2005-06,
India. Mumbai: IIPS; 2007.