What anticipatory guidance do families need about fermentable carbohydrates?

Educate families regarding how both the type of carbohydrate and frequency of consumption play a role in the caries process. Here are some points to consider:

• The anticipatory guidance will differ based on the age of the child. For example, ask families of infants if they prop the bottle or put the baby to sleep with a bottle of formula, milk, or juice. Advise them on ways to encourage their baby to sleep without a bottle in the mouth. If a bottle is necessary, plain tap water without sugary additives like juice should be recommended. For families of toddlers and older children, create awareness about foods that stick to the teeth. Avoid snacks such as gummy bears, raisins, and fruit leather. Instead, suggest fresh fruit, vegetables, cheese, or whole wheat snacks.
• Avoid pretasting, prechewing, and sharing of utensils as this may lead to the vertical transmission of harmful bacteria through saliva.
• Avoid grazing or eating snacks throughout the day in place of full meals. The sippy cup is often a grazing tool for toddlers and can impact their appetite as well as expose their teeth to frequent carbohydrates.
• Offer/suggest plain fluoridated tap water (without juice added—be sure to ask!) to quench thirst. When asking about water in sippy cups, always ask the second question: Do you add anything to flavor the water? (You may be surprised with the answers you will receive.)