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Severe early childhood caries (SECC)

-Rampant decay usually associated with inappropriate feeding practices -Children with SECC weigh less than their ideal weight for height, and their weight for age is frequently below 10th percentile

adolescents: Influential factors on eating habits

External factors -Family -Peer pressure -Mass media -Economic and sociocultural factors Internal factors -Physiological needs -Body image and self-concept -Food preferences -Personal values/beliefs toward health and nutrition

Order of introduction

Vegetables, meats, and fruits

When teeth begin to erupt, parents should

continue brushing teeth with soft infant toothbrush using fluoride-free toothpaste

Infant's gingiva should be cleaned daily with

gauze

When child is able to expectorate (usually 2 to 3 years old), _____ amount of fluoride toothpaste can be used

pea-sized

Infants typically eat ______ times / day at ___-hour intervals

six times/ day at 4 hour intervals

Suckling is replaced with

sucking by 4 months

Feeding patterns in first 2 years of life create environment for

optimal development of genetically determined factors contributing to orofacial development and swallowing patterns

Feeding issues affecting oral health

At-will nighttime breastfeeding should be discontinued once teeth erupt Infants and toddlers should not be given a bottle at bedtime Toddlers should be weaned from the bottle by 14 months Infants and toddlers should begin drinking from a cup as soon as they can sit up and hold it A sippy cup between meals with juice, soda, or other sweetened liquid places the child at risk for caries

Maxillary molars are affected first by early childhood caries. Artificial infant milk is more cariogenic than human breast milk. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second is false. d. The first statement is false; the second is true.

B

Adolescents: growth and nutritional requirements

Because of major biological, social, psychological, and cognitive changes; 17% of teens at nutritional risk Growth of long bones, secondary sexual maturation, and fat and muscle deposition lead to increased nutrient requirements Calcium, vitamin D, and iron especially important Only 9% of girls and 31% of boys between ages 14 and 18 get the recommended daily amount of calcium

Fluoride supplements should never be taken with a. water. b. juice. c. milk. d. soda.

C

Children with Special Needs

Mastication and swallowing problems common Bruxism is common in cerebral palsy and Down syndrome Children with cerebral palsy, Down syndrome, and intellectual disabilities likely to have abnormal sensory input and muscle tone Difficulties with sucking, swallowing, spoon-feeding skills with semisolid or solid foods, chewing, and independent feeding are common Tongue thrust associated with many of these conditions jeopardizes nutritional status

breast milk

Optimal source of nutrition for infants; incredibly complex and contains: Living cells Hormones Active enzymes Antibodies Low mineral content; ideal for immature infant kidneys Long-chain fatty acids High cholesterol count By 6 months of age, need addition of iron-rich foods or supplements

AAP recommends 5-step approach to choosing foods for meals:

Select mix of foods from five food groups Offer a variety of food experiences Avoid highly processed foods Use small amounts of sugar, salts, fats, and oils Offer appropriate portions Dietary Guidelines recommend less than 10% of total energy intake from added sugars The most powerful predictor for how much children eat is the quantity of food put on their plate Physical activity is important for bone mineralization National Academy of Medicine recommends that childcare providers give toddlers and preschool children opportunities for physical activity at least 15 minutes per hour Reasonable goal for dietary fiber intake during childhood and adolescence is approximately equivalent to age of child + 5 g per day Milk and dairy products are essential

Nutritional deficiency during tooth development affects:

Tooth size Tooth formation Time of tooth eruption Susceptibility to caries Mild to moderate malnutrition during first year of life associated with increased caries in primary and permanent teeth

Sucking motion becomes developed enough to

eat and handle semisolid foods from a spoon at 4 to 6 months of age

suckling

encourages maximum development of the genetically defined jaw and chin

soft infant toothbrush and water or infant tooth cleaner to remove

plaque biofilm

At ≈ 6 to 8 months of age, develop the ability to

receive food and perform a chewing motion

Introducing foods: 6 months

-4 to 6 oz of fruit juice diluted with equal portions of water can be introduced in a cup -Because of possible food allergy, only one new food should be introduced at a time -Order of introduction: Vegetables, meats, and fruits -Sweet foods are preferred so offer other foods first -Junior-type foods with a few lumps are introduced to initiate some chewing -Fluoride supplements recommended for children in areas without fluoridated water

Artificial Infant Milk

-Despite strict standards for infant formula, it cannot duplicate human breast milk -Nonfat cow's milk is the basis for most infant formulas -Provides 20 cal/oz -Most have been modified to include DHA for brain and retinal development -American Academy of Pediatrics (AAP) provides guidelines for electrolyte, mineral, and vitamin content -ADA recommends use of fluoride-free water to reconstitute powder formulas

Introducing foods: 4 to 6 months

-First foods introduced are usually cereals made of rice, oat, or barley -Should be presented to the infant with a spoon -Formula intake should remain around 32 oz daily -Fruit juice provides no nutritional benefit for infants younger than 6 months old

Toddler and Preschool Children: growth

-Grow approximately 2 to 3 inches/year and gain around 5 lb per year -Half of adult height achieved by 2½ to 3 years of age

Toddler and Preschool Children

-Lifelong habits and food attitudes are formed during preschool years -Parental attitudes and food preferences, eating habits, and food choices are influential in child's food preferences -When planning menus, parents must consider the child's food preferences and yet maintain control over options

Cleft Palate and Cleft Lip(Slide 1 of 2)

-Malformation in which parts of the upper lip or palate fail to grow together -Approximately 1 out of 1000 infants born with cleft lip with or without cleft palate -Drugs, heredity, or nutrient deficiencies (namely folic acid) may cause this malformation -Infants born with cleft palates are at high risk of developmental delays, including motor skills -Increased rates of dental abnormalities, including supernumerary, missing, or malformed teeth -Feeding can be major issue because presence of the cleft prevents negative pressure needed for sucking -Extra feeding time is necessary to ensure adequate nutrition -Special feeding devices needed when feeding time exceeds 1 hour -Other feeding issues include nasal regurgitation, excessive air intake, and frequent burping -Spoon feeding introduced as soon as possible

Toddler and Preschool Children: Nutrient requirements

-Most often deficient: Iron, zinc, calcium, and vitamin D -Caloric needs: 1000 cal + 100 cal per year of life -Choose nutrient-dense foods to meet growth needs

School-Age Children (7 to 12 Years Old)

-Only 22% of all children consume 3 servings of vegetables daily -Food habits and intake may suffer because children do not take time for meals -Although bakery products, soft drinks, candy, and chips are favorites, nutritious snacks are preferable

Utilizing the ChooseMyPlate Website

-Provides guidelines, tips, and encouragement for preschoolers, kids, and students -Age-appropriate activities for preschoolers and school-age children also included -Getting children involved in food preparation and cooking early increases their kitchen responsibilities

Alternative artificial baby milk

-Soy-based formulas used for infants with cow's milk allergy -Most common reason for use is relief of perceived formula intolerance (spitting, vomiting, fussiness) or symptoms of colic, although clinical studies do not indicate a benefit

AAPD recommends first dental visit by age

1

Formulas discontinued at age ____; whole milk provided until age _____

1, 2

Human breast milk provides distinct advantages over commercially produced formulas because the infant's system is not fully developed a. Both the statement and the reason are correct and related. b. Both the statement and the reason are correct but are not related. c. The statement is correct, but the reason is not correct. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct.

A

To help prevent early childhood caries (ECC), the dental hygienist should recommend the infant a. not be given nighttime bottles. b. drink pasteurized skim milk. c. eat iron-rich foods. d. drink fruit juice.

A

Each is true of human breast milk, except one. Which is the exception? a. It is normally thin with a slightly bluish color. b. It contains long-chain fatty acids. c. It is low in cholesterol. d. Fat digestion cannot occur for several months after birth. e. Although iron content is low, it is utilized efficiently.

C

Tooth eruption patterns of school-aged children are marked by exfoliation of all or most primary teeth and eruption of permanent teeth. During this period, application of topical fluoride is less effective than systemic fluoride administration. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second is false. d. The first statement is false; the second is true.

C

Fluoride supplementation is recommended for all infants older than 6 weeks because this mineral increases the strength and acid resistance of developing tooth enamel. a. Both the statement and the reason are correct and related. b. Both the statement and the reason are correct but are not related. c. The statement is correct, but the reason is not correct. d. The statement is not correct, but the reason is correct. e. Neither the statement nor the reason is correct.

D

Infants who are given artificial infant milk tend to weigh less than breast-fed infants. No artificial infant milk can match the benefits of breast milk. a. Both statements are true. b. Both statements are false. c. The first statement is true; the second is false. d. The first statement is false; the second is true.

D

Preschool Children (4 to 6 Years Old)

Independent in feeding themselves Cutting fruits and vegetables into small pieces increases acceptance Prefer foods separate rather than mixed Parents need to model appropriate eating behaviors Snacks important to ensure adequate nutrient intake Easy-to-chew foods more readily accepted May need 8 to 15 exposures to new food before acceptance

Contributing factors for early childhood caries

Infection with Streptococcus mutans from caregiver Addition of frequent or prolonged exposure to a fermentable carbohydrate will inoculate S. mutans A bottle at bedtime and frequent daytime bottles or habitual use of a no-spill training cup increase caries risk Prevention starts before birth with guidance to parents

Dental Caries in School-Age Children

More than 55% of children aged 6 to 15 have dental caries 21.5% ages 6 to 9 years and 11.4% of children 13 to 15 have untreated cavities Some racial, ethnic, and lower socioeconomic groups have more caries Systemic fluoride is effective before eruption and during mineralization phase of erupting teeth Application of sealants aids in reducing caries risk

Early childhood caries (ECC)

Presence of one or more decayed, missing (due to caries), or filled tooth surfaces in any primary tooth in child younger than age 6

Attention-Deficit/Hyperactivity Disorder

Promote a nutritionally well-balanced, high-protein diet Limit added sugars Add more complex carbohydrates Restriction of synthetic food color additives

Adolescents: nutritional advice

Promoting change is more important than providing information Techniques, such as negotiation and reflective listening, can enhance their critical thinking skills Effective tactics are to appeal to their physical image or their muscular development

Toddlers (1 to 3 Years Old)

Some finger foods should be provided at every meal Toddlers can manipulate cup by age 18 months Provide regularity with meals and snacks Offer small amounts of food several times/day Serving size is dependent on appetite Food jags are common; continue to offer well-balanced meals; let children choose from what is offered Prevent choking by closely supervising children while they're eating