30th August 2018

Weaning the bedtime bottle

Whilst parental apprehension around losing the bottle is entirely understandable – especially when sleep is already sufficiently challenging for a family to be in touch with a sleep consultant – it is often that the bottle itself is a big part of the problem. If a child relies on a bottle to fall asleep at bedtime, it is likely to be a sleep crutch or association. When a child has a sleep crutch (or crutches as is often the case) they generally don’t just need that thing at bedtime, almost inevitably it will also be required to resettle them when they wake in the night. And it is when they wake rather than if – every single human-being wakes during their overnight sleep. Children who “sleep-through” wake – they are just able to return themselves to sleep without requiring the parent to put a sleep association into place. For this reason, a child who needs a bottle to fall asleep at bedtime is unlikely to sleep through the night – even once they are developmentally able to do so.

 

Timing is everything

The Department of Health recommends introducing your baby to a cup from around six months, with the aim of having ceased using bottles altogether by your little one’s first birthday. In fact, it’s not just bottles that experts say should be phased out by the end of the first year – cups with a non-spill valve, whilst likely to create less mess, inhibit a little one learning to sip rather than suck drinks. Ideally, valve beakers will be bypassed altogether with a little one starting off using a free-flow cup. For parents worried a 6 month-old with a free-flow cup is a recipe for mess, the two-handled versions offer little hands a greater level of control.

But even if there are some spillages whilst a little one gets to grips (literally!) with a sippy-cup, it really is worth positioning your child to be teat-free by the end of their first year. Award winning dental hygienist, Anna Middleton (the London Hygienist), explains why: “It’s not the sucking at a young age that is a problem - that is a child’s natural comfort mechanism. It is the frequency of sucking something over a number of years that causes problems, especially if it continues after the baby teeth have fallen out. Some of the problems that can arise include the top front teeth slanting out, the bottom front teeth tilting in, the upper and lower jaws being misaligned, and the roof of the mouth narrowing from side to side.”

 

Healthy habits

Where a child has a strong sleep association with the bottle, there are often other issues which arise. A significant concern is where a little one falls asleep whilst drinking their bedtime bottle or almost immediately thereafter, with no teeth-brushing in between. This means they are spending the entire night with milk residue on their teeth. Whilst milk has many healthy qualities and is an essential part of a child’s diet, it is naturally high in sugar and teeth are particularly vulnerable at night, as Anna explains:

“Teeth are most at risk at night because there is less saliva in the mouth to protect them. At night time the milk will be in permanent contact bathing the teeth and children’s’ enamel is not as strong as adults’ enamel.  Water is the best drink to give at bedtime as milk contains naturally occurring sugar, just like fruit. When a child continually eats, snacks, and consumes drinks that have sugars and other carbohydrates, the bacteria in the mouth are fed and produce acid. This attacks the teeth which increases the chances of developing decay. This can cause pain, lead to dental abscess, and can put that child at a higher risk of decay in adulthood.

With all foods and drinks its not the amount of sugar or acid you have, it’s the frequency over which they are had. Keep these to meal times only to reduce the risk of decay. Start brushing as soon as the first tooth appears (usually at about 6 months of age), at least twice a day, especially at night with fluoride toothpaste as it will continue to protect the teeth while your child is asleep.”

It’s about more than teeth

It's not just teeth that we have to worry about when a child falls asleep with their bottle – their ears are at risk too. Whilst bottle-fed babies are always at higher risk of ear infections than their breastfed contemporaries, the risk is particularly high if a little one drinks from a bottle whilst lying down. This is because as a child sucks and swallows in a horizontal position, fluid (and germs) flow from the throat into the open tubes of the inner ear which can cause infection. In my experience, whilst very few parents would allow their baby to take a bottle lying down, as little ones enter toddlerhood, this practice becomes more common.

 

Daytime matters too

Around their first birthday is when many little ones are starting to walk. Once a child is toddling around the place, he is likely to take his bottle with him. Continual sipping between meals will affect both his teeth and his appetite. After the first year, food rather than milk should be a child’s primary source of nutrition. There is good evidence that toddlers who are still drinking from a bottle tend to drink more than the recommended intake of milk for their age. This can lead to deficiencies in key minerals such as iron (and in turn, iron-deficient children often have sleep issues). Furthermore, research has demonstrated a link between prolonged bottle-use and obesity with children who are still drinking from a bottle on their second birthday being 30% more likely to be obese aged 5 and a half.

Sometimes parents will have replaced the contents of the bottle with juice – unfortunately this is just as bad for teeth. Anna’s expert take on this is: “Even unsweetened, diet and reduced-sugar juices and smoothies contain sugar and acids. Never put them in feeding bottles. If your child is thirsty, best to give them water, rather than encouraging the taste for something sweet. Diluted fruit juice (1-part juice, 10 parts water) can be given to children after 6 months but keep this to meal times only. Undiluted juice/smoothies are ok after but only after 5 years old and should be kept to no more than 150ml, again with a meal only. As for fizzy drinks, it’s a no from me”.  

 

The critical window

As daunting as losing the bottle may appear, there is little positive benefit to a little one retaining their bottle as they head into their second year. In fact, children go through a particularly acute phase of development between 15 and 18 months where they cling tightly to security items and the bottle is likely to be high on the list if it still features during this key period. For this reason, parents will have an easier time weaning their little one from the bottle around their first birthday and certainly before 15 months. It may be helpful to replace it with another security item such as a soft toy or comforter.

Here’s how

If your little one is 12 months (or older), here is my advice for weaning the bottle…

  1. Introduce a cup if you haven’t already. You might need to experiment a little to find the one that suits your child best. If you have an older toddler involve them in choosing their new, super-special “clever boy” cup. Don't try to sneak the change in - be open and honest with your child about what is going to happen; 
  2. Begin to eliminate bottles one-by-one. The easiest one to start with is likely to be the lunchtime bottle – or the one closest to the middle of the day. Still offer milk at this time but serve it in the new special cup. If your little one doesn’t want milk in his cup then don’t force the issue but do not revert to offering a bottle.
  3. Depending on how quickly your little one adjusts to the lunchtime change, around four to seven days later begin offering his late-afternoon/dinner-time milk in a cup instead of a bottle.
  4. This is likely to leave you with just the wake-up and bedtime bottles. However, if there are other daytime bottles follow the same process to remove one every four to seven days until only the wake-up and bedtime bottles remain.
  5. Eliminate the morning one first by simply starting the day by going for breakfast once your little one wakes for the day.
  6. Last of all work on eliminating the bedtime bottle. There are a couple of ways to do this. If your little one doesn’t use his bottle as part of falling asleep, and particularly if he has adjusted well to the daytime bottles going, you may be able to simply switch bedtime milk from a bottle to a cup. Often it is the one-to-one time with a parent and the comfort of a nice cuddle that little ones are looking for – these things can still be provided! In fact, I would actively encourage parents to offer their child extra comfort and reassurance during this transition. We always want to be brushing teeth after the last milk of the day so a routine of milk, teeth-brush, snuggles and stories then bed is ideal.

If your little one is very attached to his bedtime and you know deep-down that it’s how he knows falling asleep to be, it is going to take a little more work to become bottle-free. This is because your child won’t yet know a different way of falling asleep. This is where gentle sleep-coaching will assist to equip your little one with the skills he needs to initiate sleep without using the bottle as a crutch.

Once you have built your child’s sleep skills so that he can confidently fall asleep in a different way, you can either go straight to offering his milk in a cup earlier in his bedtime routine (and always before brushing his teeth), or continue to use the bottle short-term but steadily reduce the amount of milk in the bottle – by at least 50ml every couple of days. Once you are down to the equivalent of a cup-full then switch to offering it in a cup.

As soon as you have eliminated the bedtime bottle, throw away every bottle that you own! Do not be tempted to keep one “for emergencies” or that your little one might happen upon. Removing the bottle can take weeks but once the switch has been made, it’s a huge milestone under your belt. Children adapt remarkably quickly but consistency is key – if you revert to a bottle in desperation to resettle a 3am wake up or avert a particularly intense meltdown, the crutch has been reintroduced and your hard work has been for nothing. Worst still, it moves the boundary for your little one as it makes the bottle an outcome that can happen which gives some children the resilience to hold out long and hard for it, which will be upsetting for both of you. Weaning the bottle for children over a year is universally advised for all of the reasons discussed in this article and whilst resorting to offering it may be the path of least resistance in the short-term, it will only make it harder on your child the next time you try to remove it.

This article was written with much appreciated expert input from Anna Middleton, London Hygienist. Read more about Anna below and see the links to her website and social media pages.

About Anna

Anna is a dedicated and passionate award-winning dental hygienist. She started her business 'London Hygienist' with the mission to change the way oral health care is delivered to patients.

Anna studied at The Eastman Dental Hospital after working as a dental nurse, and graduated in 2015 from the Faculty of Royal College of Surgeons. Since qualifying Anna has attracted an ever-growing and loyal customer base from the public, press and celebrities alike. This – along with her superior and unrivalled dental service in the heart of London - means Anna is regarded as one of the most popular and sought-after hygienists in London and a rising star within the industry.

Anna is a key opinion leader for Philips, an oral health panel expert at Compare The Treatment and an ambassador for the British Society of Hygienists and Therapists.

https://www.londonhygienist.com/

https://www.instagram.com/londonhygienist/

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Lauren Peacock - Sleep Specialist - UK
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