What to Expect the First Year (79 page)

Your baby wasn't born yesterday. And unlike a relative newcomer, she's developed a strong sense of what she wants, what she doesn't want, and how she can best go about getting things her way. What she wants: your nice, soft, warm nipples. What she doesn't want: a factory-made substitute. How she can best go about getting things her way: crying for the former and rejecting the latter.

Waiting this long to introduce a bottle into your baby's life has turned the odds against you—the introduction is better made no later than 6 weeks (
click here
). But it's still possible that you'll be able to win her over by following these tips:

Feed her on an empty stomach.
Many babies will be more receptive to the bottle as a source of food when they're in the market for something to eat. So try offering the bottle when your baby is really hungry—she may just take the bottle bait.

Or feed her on a full stomach.
With some babies, offering a bottle when they are looking for a breast just plain makes them mad. If this is the case with your baby (and you'll find out only through
trial and rejection), don't offer the bottle when she's at her hungriest. Instead, offer it casually between nursings. She may be more in the mood to experiment and more open to a snack.

Don't let her see you sweat.
Instead of acting as though there's a lot at stake (even if there is), act as if the bottle issue is no biggie, no matter what her response.

Let her play before she eats.
Before attempting to get down to business with the bottle, let her get her hands on it. If she's had a chance to explore it on her own, she may be more likely to let it into her life and, hopefully, into her mouth. She may even put it there herself—as she does everything else.

Banish your breast.
And the rest of you, when the bottle is launched. A breastfed baby is more likely to accept a bottle from those lacking lactation equipment—in other words, anyone but mom. It may also help if you and your breasts are out of smelling distance. At least until bottle-feeding is well established, even the sound of your voice may spoil baby's appetite for a bottle.

Try a favorite fluid.
It's possible that baby's objecting not to the bottle but to the fluid inside it. Some infants will take to a bottle better if it's filled with familiar breast milk, but others, reminded of breast milk's original source, are more open to another beverage. If your baby's doctor has okayed water, give that a whirl first.

Sneak it in during sleep.
Have your bottle giver pick up your sleeping baby and try to offer the bottle then. After a few weeks, your little stubborn bottle snubber may open wide when wide awake, too.

Know when to surrender—temporarily.
Don't let the bottle become the object of a battle, or your side doesn't stand a chance of winning. As soon as your baby raises objections to the bottle, take it away (again, like you could care less) and try again another day, and then another. Offer the bottle once every few days for at least a couple of weeks before you consider giving up entirely.

Even if baby never ends up budging on the bottle, don't give up hope. There's another alternative to your breasts: the cup. Many babies can master a cup by 6 months or so and happily take supplementary feedings from it (
click here
), and most become skilled enough cup drinkers by the end of the first year to be weaned directly from the breast to the cup—which saves the extra step of weaning from the bottle.

“I have a friend whose baby's front teeth had to be pulled because of tooth decay. How can I prevent this from happening to my son?”

There's nothing cuter than a first grader whose grin reveals an adorable space where his two front teeth used to be. But losing baby teeth early to decay (so-called baby-bottle mouth) isn't so cute. It also doesn't just affect a baby's smile. It's painful, can lead to infection if not treated, and can result in problems with eating and speech development.

So you're smart to think prevention—and happily, baby-bottle mouth is completely preventable. It occurs most often in the first 2 years of life, when teeth are most vulnerable, and most frequently as a result of a baby's falling asleep regularly with a bottle (or much less often, a breast) in his mouth. The sugars in whatever beverage he's sipping (formula, fruit juice, even breast milk) combine with bacteria in his
mouth to erode that brand new enamel and decay the teeth. The dirty work is done during sleep when the production of saliva, which ordinarily dilutes food and drink and promotes the swallowing reflex, slows dramatically. With little swallowing occurring, the last sips baby takes before falling asleep pool in his mouth and cling to his teeth for hours.

Some babies are more susceptible to baby-bottle mouth because of a genetic predisposition. So, if you or your partner get lots of cavities, that might put your little one at greater risk. That said, any baby can get tooth decay in those first precious pearlies under the right—or, in this case, the wrong—conditions. To avoid baby-bottle mouth:

• Once your baby's first teeth come in, don't put him to bed for the night or down for a nap with a bottle of formula or breast milk. Give the bottle before you put him down, and if it's nighttime, brush his teeth after the feed. If he takes a bottle to bed, fill it with water only, which won't hurt his teeth (and if it's fluoridated, will help strengthen them). Avoid juice in bottles altogether.

• Use bottles for feeds, but not for pacifying. All-day nipping (crawling around with a bottle, or always having it handy for sips while playing) can be as harmful to the teeth as nighttime sucking. Bottles should be considered part of a meal or snack and like these should routinely be given in the appropriate setting (your arms, a baby seat, a high chair or other feeding chair) and at appropriate times.

• Dilute even 100 percent fruit juice at least half-and-half with water, and serve it in a cup instead of a bottle (or skip the juice altogether). Avoid drinks with sugar added, such as cranberry juice cocktail, fruit punches, or fruit drinks.

• Drop the bottle at 12 months, as recommended by the AAP.

• Whatever goes for bottles goes for sippy cups as well, which also allow fluids to pool in a baby's mouth—so set similar limits with sippies. Straw cups or regular cups (as they're introduced) are a better dental bet.

• While baby-bottle mouth is far less common among breastfed babies, be wary of all-night nipping at the breast, too, once teeth arrive.

“My baby just got her first tooth. The doctor said I should start brushing it now, but that seems silly.”

Those tiny pearls that bring so much pain before they arrive and so much excitement when they first break through the gums are going to fall out during the early and midschool years, to be replaced by permanent teeth. So why take good care of them now?

For several very good reasons. Since they hold a place for the permanent teeth, decay and loss of these first teeth can deform the mouth permanently. Not to mention that your baby will need these primary teeth for biting and chewing for many years—so it's important they are as healthy as can be. Healthy teeth are also important for the development of normal speech. Finally, and probably most important, getting your baby in the brushing habit early will make it second nature by the time that second set of teeth comes in.

The first teeth can be wiped clean with a damp gauze pad or washcloth, or a tooth wipe or finger brush designed for infants, or you can brush them with an infant toothbrush. Less is more when it comes to traditional bristle brushes—choose one with no more than three rows
of very soft bristles, and swap for a new one when it gets rough around the edges (which will happen pretty quickly if baby likes to chomp down during brushing). Or opt for a flexible brush with silicone bristles—these are gentler, more durable, and offer a soothing gum massage during teething bouts. They're also dishwasher safe (so they're easier to keep clean). Some come with a wide handle or a silicone shield to keep baby from pushing the brush too deep into her mouth.

Aim for brushing or wiping teeth after meals and at bedtime. Be gentle, since baby teeth are soft and gums are tender. Lightly brush or wipe the front of the tongue, too (going too far back can trigger gagging), since it can harbor germs.

What about toothpaste? According to the American Academy of Pediatric Dentistry (AAPD), it's a good idea to start brushing baby teeth with cavity-preventing fluoride toothpaste right from the start—instead of waiting until age 2, as was previously recommended. But remember that size very much matters. To avoid overdosing a baby or toddler on fluoride, use just a rice-grain-size smear of toothpaste, graduating to a pea-size blob at age 3. Experts say those quantities probably won't generate mottling of the teeth, even if your little one swallows some paste (she will). In the second year you can start trying to teach her the fine art of spitting.

Though brushing is the first line of defense against tooth decay, there are other preventive steps you can take to ensure a lifetime of healthy teeth, such as those listed in the previous question, as well as:

• Limiting refined carbs (bread, crackers, and teething biscuits made with white flour) in your little one's diet since they quickly turn into sugar on your baby's pearly whites, posing as much of a cavity risk as candy. Whole grains aren't only more nutritious, but they're also better for baby's teeth.

• Setting limits on bottles and sippy cups (see previous answer).

• Checking up on your baby's mouth and teeth. The doctor probably does a check at each well-baby visit—and unless there are signs of decay or other issues, that's likely all she needs now. The American Academy of Pediatric Dentistry recommends a visit to the dentist (a pediatric dentist or a regular dentist who sees children) around the first birthday—and an early visit can help get your little one acclimated to dental checkups—but if all is well and she's getting her teeth checked regularly by her pediatrician, it's fine to hold off until your little one turns 3.

• Asking about fluoride. Most babies over 6 months get all the fluoride they need from fluoridated drinking water (and a smidge of fluoride toothpaste). If your baby doesn't, ask the doctor about whether you should add a fluoride supplement.

“Our baby loves eating vegetables and fruits, but he doesn't seem to like cereal. Does he need to eat cereal?”

It's not the cereal that babies need, it's the iron it's fortified with. For the formula-fed set, cereal snubbing isn't an issue, since these babies fill their requirement for this vital mineral every time they drink a bottle. Nursing babies, however, need another source of iron once they've reached the 4-month mark. Fortunately, while fortified baby cereals are a very popular alternative source of iron (at least, among the majority of beginning eaters and their parents), they're not the only one. Breastfed cereal spurners can easily fill their requirement with an iron supplement.

And before you close the pantry door on all cereal, you might want to try offering baby another variety that you haven't introduced yet—barley, perhaps, or oat. It's possible that his more adventurous taste buds naturally prefer a slightly stronger taste (rice is definitely the blandest of the bunch). Whatever cereal you choose, whole grain is the best bet nutrition wise, and tastier, too. Or consider mixing a small amount of cereal with one of the fruits he enjoys (no need to sweeten the cereal deal with fruit, however, for a baby who already enjoys it straight up).

“We're vegans and plan to raise our daughter the same way. Can our diet provide enough nutrition for her?”

Your little sprout can grow up to be just as healthy as any milk-drinking or meat-eating tot—and with the right food choices, maybe even healthier. Just remember to: