A good diet is essential for a child’s overall growth. Like the rest of the body, the teeth, bones, and soft tissues of the mouth also need a healthy diet. Good nutrition promotes oral health and development of healthy teeth and gums to allow children to chew and swallow food.

Seems simple enough? Not so. Even some healthy foods can promote development of dental caries (cavities) and plaque buildup. Food has the potential to have both positive and negative effects on a child’s oral health.

Beverages and Oral Health

For many years, experts have focused on identifying food items that cause dental caries. Today, the focus not only is on reducing certain cavity-causing foods, but also on the frequency of eating, good oral hygiene, and overall healthy nutrition.

One example is fruit juices. The American Academy of Pediatrics recommends that fruit juice intake be limited to 4-6 ounces per day (less than a cup) for children ages 1-6 years old. Yet most children consume at least 12 ounces per day.

It is well known that consuming fruit juices, which contain sucrose (a type of sugar) is a risk factor not only for obesity, but also for dental caries. Fruit juices consumed from a bottle or sippy cup between meals or at bedtime--and not followed by toothbrushing--increase that risk even more. It is wise to offer juice to infants and young children by using a cup only at mealtimes.

Why? Because when children are allowed to sip the juice throughout the day or night, the sugar sits on the teeth for long periods. This can lead to decay, or what is commonly called "baby bottle tooth decay."

Baby bottle tooth decay refers to tooth damage often caused when infants or toddlers are put to bed with a bottle or sippy cup. Not only does this practice allow the teeth to bathe in milk or juice all night, but it also presents a potential choking hazard,

A better alternative is to give children pieces of fruit with meals or as snacks rather than fruit juice. While fruits do contain sugar, studies show that sugar within the cellular structure of fruits is less likely to cause cavities.

What about milk? Milk taken with or between meals in a regular cup is very beneficial to a child’s overall health. Protein, calcium, vitamin D, phosphorous, and casein, all found in milk, are very important to tooth mineralization and building strong teeth. Furthermore, lactose, the type of sugar in milk, is the least likely type of sugar to cause caries.

Sticky Foods

Avoid "sticky" foods as snacks. Sticky foods are those that stay in the mouth longer and tend to adhere to the teeth and gums, making them more likely to contribute to tooth decay.

Foods such as crackers, raisins, chips, pretzels, zwieback (teething crackers), bread, and dried fruits adhere to the teeth even after chewing and swallowing. Snacks that can be quickly chewed and swallowed such as raw vegetables, bites of cheese, and sliced fruit are better choices. Remember, avoid choking hazards by shredding, dicing, or slicing foods to appropriate sizes.

Young children should be offered a variety of snack foods that are nutrient dense, i.e., foods that are rich in nutrients compared to their calorie count. Nutrient dense foods provide energy and build tissue.

A good example of a nutrient dense food is strawberries. One cup of strawberries contains only 150 calories, and has 3.5 grams of fiber, folate, and more than 100 percent of the daily recommended amount of vitamin C. And, strawberries do not stick to the teeth!

Frequency of Snacking

The frequency of snacking also can affect the child’s oral health. When snacks containing sugars or starches are eaten, the bacteria in plaque use these sugars to produce acids that attack tooth enamel.

Over time, tooth enamel breaks down and forms a cavity. Frequent eating means more opportunity for these acids to work. Ideally, sugary snacks should be eaten with a meal when more saliva is available to neutralize the acid and clear food from the mouth. Eliminating or reducing sugary snacks is the best option.

Nutrition Tips to Promote Oral Health

• Encourage infants more than six months of age and toddlers to drink water or milk instead of juice. Limit juice consumption to four ounces a day served from a cup.
• Offer cut fruit rather than fruit juices.
• Teach children to drink from regular cups; avoid sippy cups if possible. If parents prefer to use sippy cups at home, encourage them to provide them only at meals or snacks. Do not allow children to drink from a bottle or sippy cup throughout the day. Again, try to prevent foods and liquids from "pooling" in their mouths.
• If a cup is provided for the child at bedtime or nap time, be sure it contains only water.
• Plan sit down meal and snack times. Discourage "grazing" throughout the day.
• Serve tooth-healthy foods such as sliced vegetables, fruits, soft cheeses, and yogurt. If serving sticky foods such as crackers, pretzels, dried fruits, or granola bars, follow-up with tooth brushing.
• Instruct young children to brush after meals or snacks. If brushing is not possible, teach children to swish water in their mouths to help remove food particles.
• Wipe infants’ gums after feeding with a dampened soft cloth.
• Provide teething children with cold wash cloths or teething rings; avoid zwieback teething crackers.
• Never leave an infant with a propped bottle. Infants should always be held while feeding.

Teaching Children

In addition to instructing children how to brush and floss their teeth, teach them that what they eat and drink is important for keeping their teeth healthy. For example, teach children that some foods will stick to their teeth.

To demonstrate, gather a variety of sticky things for children to explore such as self-stick paper, syrup, marshmallows, glue, hair gel, stickers, etc. Invite children to touch the different things and talk about how each feels. While children are washing their hands, ask which things are the easiest and which are the hardest to wash off and why.

Elaine Abrams, RN
Certified Health Educator and Community Health Coordinator, Nursing & Home Care, Wilton, CT

Internet Resources

CNN, Children’s Snacks, www.cnn.com/HEALTH/library/HQ/00419.html

KidFood, ceplacer.ucdavis.edu/newsletterfiles/KidFood_Newsletter_Current_Issues4514.pdf

Snack Smart for Healthy Teeth, www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/ChildrensOralHealth/SnackSmart/default.htm

Snacking and Your Teeth, healthresources.caremark.com/topic/snacking

Tooth Friendly Snacks for Toddlers, www.babycentre.co.uk/toddler/caringfor/toothfriendlysnacks

Resources

Food & Nutrition Information Center, National Agricultural Library, 10301 Baltimore Ave., Rm. 105, Beltsville, MD 20705; 301-504-5414; www.nal.usda.gov/fnic/contact.shtml