Early Childhood Issues


Teething is a natural process that usually occurs at about 6 months of age. However, some infants exhibit signs of systemic distress such as crying, increased drooling, high fever, diarrhea, facial rash, sleep difficulty and mild pain. There is a tendency for the child to bite, chew and place their fingers in the mouth. One theory as to the etiology of the symptoms is the timing coincides with the loss of maternal antibodies and the symptoms are reflective of a systemic infection. Treatment is palliative; increased fluid consumption, non-aspirin analgesics, teething rings to apply cold and pressure to the gums. Topical analgesics containing benzocaine should be avoided because of the possibility of methemoglobinemia developing especially in children under 2 years of age. Children with high fevers should be evaluated by their pediatricians.

Image: Teething - crying toddler

Early Childhood Caries (ECC) - Nursing Caries, Baby Bottle Caries

Early childhood caries is due to consumption of fermentable carbohydrate liquids (juices, sodas, infant formula, cow and mothers milk) during excessive bottle feedings and/or prolonged breast feedings. It affects 1-12% of the pediatric population in developed countries and up to 70% in underdeveloped countries.

Image: Early Childhood Caries (ECC) - Nursing Caries, Baby Bottle Caries
Effects of ECC are demonstrated by initial caries involvement of the maxillary anterior teeth, the maxillary and mandibular first primary molars, and the mandibular canines. Depending on severity the mandibular incisors are unaffected. As early as twelve months, demineralized enamel takes on a chalky white appearance. As caries progresses into dentin, brown lesions form gingivally. Untreated lesions progress into the pulp and eventually abscess.
Image: Effects of Early Childhood Caries
Image: Effects of Early Childhood Caries
The distinctive pattern of ECC is due to an interaction of factors.
  • The child ingests liquids containing fermentable carbohydrates at sleep time.
  • The liquid pools around the maxillary incisors, maxillary and mandibular molars and mandibular cuspids due to a reduction in salivary flow and swallow reflex. The anterior position of the tongue under the nipple of the bottle or breast protects the mandibular incisors.
Image: Distinctive pattern of Early Childhood Caries

Treatment of ECC includes:

  • Ideally the child is weaned off the bottle by twelve months and is encouraged to drink from a cup. The American Academy of Pediatric Dentistry recommends weaning by 12 months. The American Academy of Pediatrics recommends weaning by 18 months and introduction of a cup at 12 months.
  • If that is not possible, water should be substituted for the fermentable liquid. The author’s technique is to recommend to the parents to dilute the fermentable liquid with water by 25%. This level was maintained for two nights. The fermentable liquid was diluted by another 25% for two more nights. Subsequent dilutions were continued until the bottle contained 100% water.
  • Treat white spot lesions with fluoride varnish.
  • Restore or extract the carious teeth
Image: Treatment of Early Childhood Caries
Image: Treatment of Early Childhood Caries
Early extraction of the maxillary incisors (prior to speech development) may lead to speech problems. It can also cause a self image problem in the child (and to an extent, the parent). Replacement of extracted teeth with a prosthesis may be recommended for proper speech development and aesthetics and if the child is able to tolerate the appliance.