Appendix 2

Teeth, Sleep and Activity

Teeth and Tooth Care

On average, the first teeth appear at six months. Some babies get teeth earlier and some later. Once teething has started it’s a pretty regular event until all teeth have arrived. Whatever age they start to erupt, all 20 are usually present by the time your child is two and a half years.

Teething can start from three months and your baby’s gums may be tender. Some babies seem more bothered by teething than others. Teething doesn’t make a baby ill, so if your baby is suffering from rashes, a temperature or diarrhoea, you should not presume it is due to teething.

If your baby has sore gums, he may go off eating for a day or two – this is perfectly normal and his appetite should come back when he’s feeling better. There are a number of products to help your baby with teething, such as teething rings that you chill in the fridge, plain teethers to bite on, homeopathic products or numbing gels. If you do use a numbing gel, don’t use it just before you feed your baby as it will be more difficult for him to eat with a numb mouth. This could decrease your baby’s ability to move food around his mouth and increase the risk of choking.

There are two consistent questions about teeth that parents ask me. Firstly, they ask: ‘Can my baby eat lumpy foods without teeth?’

Babies can eat lumpy foods without teeth; they have hard little gums and can manage soft lumpy foods well.

The second question parents ask is: ‘Do I need to clean my baby’s milk teeth as they are going to fall out anyway?’

Yes, you do have to clean your baby’s first teeth. Baby teeth can decay; not only is this painful and unsightly, it can spread quickly round a baby’s mouth, affecting other teeth. In some cases it may lead to the tooth or teeth being removed. The first teeth hold the space for the permanent tooth that will move into that place. If a first tooth is missing the other teeth will move to fill the gap. This puts the permanent tooth at risk of being damaged and growing crooked.

When your baby’s first teeth have appeared, clean them twice a day with a small toothbrush and an age-appropriate toothpaste that contains the right amount of fluoride. Make sure to use the toothpaste as directed.

Exposing teeth to sugar causes tooth decay. Never give your child sugary drinks, including juice, through a bottle or a non-spill beaker. The more frequently the teeth are exposed to sugar, through drinks, sweets or other sweet foods, the greater the risk of decay. If you do give your baby fruit juice at any time, it must be in a cup or free-flow beaker, diluted with water (one part juice to ten parts water) and drunk in one sitting. Allowing your child to continually sip on juice prolongs the time it is in contact with his teeth. Ensure you have a family dentist and ask the dentist at what age they will start to see your child – it’s generally around two years but each dentist is different.

Sleep

It is worth mentioning sleep in a weaning book because with babies sleep and feeding are associated subjects. The question nearly everyone asks is: ‘Does a baby who wakes in the night require solid food?’

Waking at night is not a reliable sign that your baby needs solid food. If your baby is less than six months old he may still require milk feeds at night and it is preferable to feed your baby his usual milk rather than introduce solid foods.

There are things you can do at bedtime to maximise your baby’s chances of sleeping through the night and to get good sleeping habits in place. Having a good bedtime routine helps your baby to know what is happening and settle down for the night. It may be a bath or story, and it is likely to involve a feed. Try not to feed or rock your baby to sleep. Ideally you want to be able to put your baby into his cot awake and let him fall asleep by himself. Babies associate what happens to them at bedtime with going to sleep. When your baby wakes at night, and we all do, he will look for the thing that puts him to sleep. If that thing is being rocked he will call to you to rock him; if it’s feeding, he will want to be fed. If it’s sucking a dummy he will want you to come and find the dummy (which will have fallen out) and give it back to him. If your baby can put himself to sleep, there is a chance, unless he really wants something or is ill, that he will be able to go back to sleep without being rocked, fed or sucking a dummy.

Of course if he is hungry he will still ask to be fed. It is worth separating the last feed at night from the moment you put your baby into bed. You can do this by giving your baby his feed, then his bath and then bed. Or you can stop the feed before your baby falls asleep so that you lie him down awake. Learning to self-settle is a key skill for babies and helps them sleep at night. If your baby is under six months, night feeds should not be denied.

If your baby is over six months it is unlikely that he needs to feed at night-time, and your first step in helping him sleep through is the same as above: help him to self-settle. If he still wakes for a feed (and your baby is otherwise well and gaining weight appropriately) you can slowly reduce the volume of the feed. If he is bottle-fed, reduce the feed by an ounce or two for a few nights, then reduce again and so on until the feed is no longer worth giving. If he is breastfed, reduce the feed by minutes over a few nights.

If you’re having problems with sleep speak to your health visitor, who can help you decide how to tackle the problem.

Activity

Activity and food are related subjects. Not only do children need good food to grow well, they also need to be active. This helps them develop strong bones and muscles, and get into the habit of being physically active to prevent them becoming overweight. Physical activity also helps children develop friendships and social skills.

In 2011 the UK released physical activity guidelines for early years children. These guidelines recommend that physical activity should be encouraged from birth. You have probably been ensuring your baby has tummy time and around three months will be playing on the floor with him. By five months your baby will be reaching, holding and pulling objects and enjoying playing with you. Create a soft area on the floor at home, or even outside if the weather is nice, for your baby to lie on and explore toys or other safe objects around him. If you haven’t already, you may want to take your baby swimming.

To help with activity you need to reduce the times your baby isn’t active. Reduce times spent in pushchairs or sitting in front of the TV. The British Heart Foundation has produced a good leaflet on how to encourage physical activity in under-fives (see Resources, here).