Blog Post 8.8.14

I apologize for the length of my first real entry on Little Sproutings. I am very passionate about this topic so I felt it was my job to address it very thoroughly!

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I recently came across an article on Parenting.com titled, “Breastfeeding Longer than 2 Years Associated with Tooth Decay,” where they cited a research study that claimed there was an association with long-term breastfeeding – that of which lasts longer than 24 months of age – with tooth decay. As a happily breastfeeding mom and a huge champion of moms being able to breastfeed as long as they are capable, I was deeply disturbed by this claim.

Not only was this statement irresponsible and dangerous, but I was also disappointed to have this article pop up from another one of their tweets during World Breastfeeding Week (August 1-7). 

First of all, breastfeeding is the best choice a mother can make for her infant/toddler (if she is not experiencing any physical problems with the ability to breastfeed). It provides the best immune system antibodies, great bonding opportunities, and helps reduce the risk of SIDS by developing a strong airway by utilizing a stronger sucking mechanism, among many other benefits that I will address in a later post. So, any attempt to find any negative association with breastfeeding leads me to criticize the source. Second, throwing a claim out there to the public – in a parenting forum – is likely going to make many families question the great decision that they have been making: breastfeeding as long as the baby will do so. 

As with any alarming or suspicious conclusions or conversely, anything that seems “too good to be true,” make sure you look into what research article they are referencing.

Here’s what to do when you find this sort of article:

Do a little digging by doing a quick google search to find the actual research article title. I found the Reuters Health article that cited one of the researcher’s names, Benjamin Chaffee. Then I went over to my trusted scholar.google.com – it was our go-to for finding research articles when I was studying for my Master’s Degrees and it shows you the actual research publication. Use the search terms that are used in the article.  I typed the headline from Parenting.com into scholar.google.com followed by the name “Chaffee” and clicked “Since 2014,” since it was cited as “recent research.” 

I found the original research article (source below) and looked into its methods and findings. Here are some of the MANY pitfalls that I have found: 

  1. This study was conducted among LOW-INCOME families in Porto Alegre, Brazil. I researched how prevalent dental care was in Brazil as a whole, and found a cross-sectional study (one that grabs an equal portion of participants from each qualifying category to get a representative sample of the entire population) and it showed that 31% of children aged 0-14 years old had NEVER had a dental visit. (Source below)
  2. The study’s methods stated that they accounted for confounding variables (things that would interfere and thus result in a bias) for “feeding habits and child growth” BUT…
  3. One of the key pieces of data used by these researchers was the intake of all fluids after 6 months of age, including breastmilk, formula, AND JUICE. **The American Academy of Pediatrics even states that children under 1 year of age should NOT BE GIVEN JUICE at all, and for those aged 1-6 years old, to limit juice consumption.** Further, those 12 months and older (since the study is for children who breastfeed after 2 years of age) provided data on junk food intake. 
  4. The study used confidence intervals to analyze their data; however, multivariate analyses (other ways to study interaction of variables) should be conducted to identify causative factors here. 

The researchers draw a very general conclusion about tooth decay and breastfeeding from a non-representative sample that has recently been used in United States media sources. This claim is not only dangerous, but it is also unfair to blame breastfeeding as the culprit rather than pointing the finger at the actual negative habits of those in this study. Feeding juice to infants and allowing children 12 months and older access to the list of junk food cited in the article, such as cookies, candy, chips, chocolate milk, soft drinks, sweet biscuits, and honey is the real problem! Babies that have just reached their twelfth month should NOT be eating these foods anyway! There is plenty of valid research showing the contribution of these junk foods to tooth decay.

I also found problems with the article on Parenting.com and Reuters Health. Sneaky writers will throw in legitimate sources, like those seen here. By citing a quote from the American Academy of Pediatrics, The American Academy of Pediatric Dentistry, or the World Health Organization (WHO), makes trusting readers and consumers believe that these great organizations agree with what is stated elsewhere in the article.

Reuters Health cited the WHO’s recommendation for mothers to breastfeed as long as possible and also referenced the American Academy of Pediatric Dentistry stating its recommendation of a first dental visit once the first tooth appears or the child is one year old. The National Center for Chronic Disease and Prevention and Health Promotion is also cited in Parenting.com’s article. By publishing statistics about tooth decay prevalence in children above two years of age, along with the statement, “Forty-eight percent of children over the age of 2 have tooth decay,” in the same paragraph implies that this is due to breastfeeding.  Parenting.com’s research source? The Daily Mail. Not the original research article. Did these respected organizations (WHO, AAP, etc.) contribute anything about how breastfeeding is associated with tooth decay? The answer is: No. 

“Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.” – The World Health Organization

Chaffee is quoted in the Reuters article saying that “Our study does not suggest that breastfeeding causes caries (cavities),”  but this quote did not make its way on to the Parenting.com article. Excessive sugar intake is most definitely a huge factor along with limited to no access to dental care. 

The Australian Breastfeeding Association does a wonderful job at addressing this all-too-frequent attack on breastfeeding and dissects the contributing factors to tooth decay. La Leche League International also addresses parents’ and dentists’ concerns about night nursing and cavities to which they put it quite nicely: “some kids get dental cavities in spite of nursing, not because of it.”

Breastfeeding does not seem to be the problem here. Not even close. I hope the writers at Parenting.com, Daily Mail, and other similarly influential outlets to parents do a much more thorough job at their research in the future before publishing such a claim. These are not pitfalls of breastfeeding; rather, these are pitfalls of poor oral hygiene. 

Sources: 

Association of Long-Duration Breastfeeding and Dental Caries Estimated with Marginal Structural Models. Chaffee B., Feldens C., Vitolo M. Annals of Epidemiology. 2014, 24 (6):448-454.

Inequalities in dental services utilization in Brazilian low-income children: the role of individual determinants. Baldani MH., Mendes YB, Lawder JA, de Lara AP, Rodrigues MM, Antunes JL. J Public Health Dent. 2011 Winter 71 (1): 46-53.

American Academy of Pediatrics: Where We Stand: Fruit Juice. http://www.healthychildren.org/English/healthy-living/nutrition/Pages/Where-We-Stand-Fruit-Juice.aspx

World Health Organization: Breastfeeding. http://www.who.int/topics/breastfeeding/en/

Parenting.com: http://www.parenting.com/toddler/health/breastfeeding-longer-2-years-linked-to-child-tooth-decay