There has always been an underlying concern about Gavin’s poor interest in food which has made me consciously aware of anything and everything related to it.  Recently, I made a few more discoveries which help to unravel the mystery and to resolve some of the unasked questions that have been floating around.

1. Lack of Molars

Last week, when I was at Kizsports, I bumped into a Mum that I used to see at Fitfor2 when we were both pregnant.  Her daughter, who has always been an avid eater, was playing at Playland and when she fell down and started wailing, I caught a view of her full mouth of teeth.  Her daughter is a couple of weeks younger than Gavin and she’s already got her molars!  The first of Gavin’s molars has yet to erupt.

Girls generally precede boys with teeth eruption, but even for a boy, Gavin is a little on the late side since, on average, most first molars usually erupt by 18-19 months.  Since Gavin only has eight incisors with which to chew, it is no wonder he hasn’t really taken to solids quite so well because it’s quite a challenge to eat with only incisors. 

We’ve also noticed that Gavin likes liquids - he hardly ever rejects liquids.  He drinks water, juice, soup and flavoured milk.  We rarely have problems getting him to drink liquids which seems to correlate with his apparent lack of interest in solids because he hasn’t got any molars.

2. The Question of Weaning

There has been concern that Gavin’s continued nursing is causing a reduction in his appetite because he drinks too much breastmilk.  Although there is plenty of evidence to indicate that there is no need to wean a child in the hope of increasing his regular food intake, the question often brims beneathe the surface of our conversations about Gavin’s poor solid intake.

Further to the evidence, I recently met a Mum who did wean her son, hoping to increase his solid intake.  Despite weaning her son, his solid intake has not increased.  Instead, he has started to drink more cow’s milk.  Quite frankly, between cow’s milk and breastmilk, I would rather Gavin drink breastmilk because:

• breastmilk is formulated especially for Gavin, while cow’s milk was intended for a calf.
• breastmilk contains a higher percentage of fat compared to cow’s milk (and since the fear of Gavin not consuming enough solids is related to his weight gain, we should be encouraging him to take more breastmilk instead of cow’s milk).

3. Selective Tastebuds

I think we’ve also established that Gavin has rather selective tastebuds.  Part of what contributes to the challenge of feeding him solids is also the fact that there isn’t a lot of flavours that he enjoys eating.  Getting Gavin to eat solids then becomes a task of finding something he can chew with just his incisors with a flavour that he likes.

For instance, I have discovered that one of the most consistent savoury flavours that Gavin enjoys is chicken.  He likes to eat chicken (albeit, it has to be cooked until it is very tender), and other chicken-flavoured food, like porridge made with chicken stock, chicken-flavoured noddles, etc.  If I ensure that there is a chicken flavour in his meal, I can usually expect him to eat some of the meal.

When you put all this into the picture, it isn’t at all surprising that Gavin isn’t really eating solids with gusto.  The fact that he likes most of the liquids we present to him is a good sign that his solid eating will pick up once he starts growing his molars.

Below: Gavin eating a cracker at my grandma’s house.

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When I first introduced the toothbrush to Gavin, he loved it.  He loved putting it into his mouth and chewing on the bristles.  I encouraged him to use his toothbrush while I brushed my teeth at the same time.  After I was done, I would help him clean his teeth properly either with the brush or with a wet cloth. 

Being so young, I was reluctant to introduce toothpaste to him because most of the children’s toothpastes we have in the market all contain fluoride.  Granted it is only 500ppm (half the concentration of adult’s toothpaste), knowing that young children don’t know how to spit out properly and usually end up swallowing everything you put into their mouths, I wasn’t keen to use toothpaste.

Don’t get me wrong - fluoride is great.  Fluoride was key in reducing tooth decay in the majority of the population and is the very reason why I remain decay free today.  Unfortunately, fluoride in large concentrations can cause fluorosis - white flecks on teeth in its mildest form all the way to severe brown mottling.  Since children have a habit of swallowing toothpaste, it is easy for them to exceed the optimal fluoride levels, especially because of their small mass.

It wasn’t long before Gavin caught on to the fact that I would apply toothpaste on my brush but not his.  At this age, Gavin likes to mimic our actions and he would follow us as precisely as he is able, so he started insisting I add paste onto his brush, too.

Not wanting to use adult toothpaste, I went hunting around for children’s toothpaste.  At Guardian, I noticed that there are four main options when it comes to children’s toothpastes:

• Colgate
• Oral B
• Darlie
• Kodomo

All of them contain 500ppm fluoride.  All of them come in fruity-flavoured variants (which I completely disagree with because the fruity flavours only serve to encourage a child to eat the toothpaste rather than spit it out).  In the end, I chose Kodomo for the following reason:

It contains xylitol.

What’s Xylitol?

“Xylitol occurs naturally in many fruits and vegetables and is even produced by the human body during normal metabolism. Produced commercially from plants such as birch and other hard wood trees and fibrous vegetation, xylitol has the same sweetness and bulk as sucrose with one-third fewer calories and no unpleasant aftertaste. It quickly dissolves and produces a cooling sensation in the mouth.”

Why Xylitol?

When I was in Uni, we had a lecture about sugar-substitutes, although our examination of such options were not so much about the calories about from a caries (tooth decay) benefits point of view.

Of all the sugar substitutes we covered Xylitol proved to be the most promising because it was not only found to be safe for consumption in large quantities, but it was also discovered to be anti-cariogenic.  In other words, it could reverse early formation of tooth decay in teeth. 

With such promise, I was surprised that it had not appeared in food as a sugar substitute at the time (this was in 1995, by the way).  It was only over the last five years that I have noticed xylitol appearing as a sugar substitute in chewing gum and only recently in toothpastes.

So far, Kodomo is the only toothpaste I have seen containing Xylitol, and that is why I recommend it.

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I’ve just realised that I haven’t written a single post about Gavin’s teeth and I’m a dentist!  Or rather, was. 

Well, Gavin is now 1 year and 1 month old and he still only has two lower central incisors (they are the two front teeth on the bottom), although the two upper central incisors look like they are about to pop through his gums any day now.  His teeth are erupting a little on the slow side considering the average age of eruption for the central incisors are around 6-10 months for the lower and 8-12 months for the upper.  I had to memorise eruption dates in first year for an oral anatomy exam but heck if I can remember them all now.  I had to be told by my paediatrician that eruption of the first tooth can be as late as 18 months and that is still completely normal.

Well, there are benefits to having Gavin cut his teeth late - at least he has less teeth to bite me with when he’s nursing.  That said, I have a number of Mummy friends who’ve asked me about biting and nursing so I guess this is a common concern among mothers who intend to nurse their babies beyond six months.  Well, I was worried about it too and I asked my BFF - who had more experience than I (her son is soon to be turning two years old) - and she gave me this piece of advice:

When baby bites, just remove your nipple and tell him, “Ouch!  That hurt!  No more milk.”  He’ll soon get the message that he shouldn’t bite Mummy’s nipple. 

Gavin’s been quite good with the biting.  He hardly ever bites and when he does, it’s usually a gentle nibble.  Biting is also a sign that baby is playing and has either lost concentration for nursing or is only pacifying because in order to suckle, baby tongue thrusts forwards and that would mean that he would end up biting his own tongue.  So if baby is biting, he is no longer nursing.

When I was in dental school, we were taught to recommend to patients to bring their babies in for their first dental check up at about 6 months.  This is because the first tooth is expected to erupt about 6 months and it is a good time to advise parents about how to take care of their baby’s teeth.  It also ensures that baby’s first experience at the dentist is a positive one (which makes it easier for subsequent follow up appointments). 

I find that the number one reason why children are afraid of the dentist is because their first visit to the dentist is because they already have problems with their teeth.  A lot of people have the misconception that they only need to visit the dentist when their teeth hurt, but the problem is, when your teeth hurt, it usually means that the problem has escalated to something really big. 

It’s a catch 22 really.  Whenever a friend tells me about a dental problem they have, I’ll ask, “Why don’t you see a dentist?”  The reply inevitably will be, “I’m afraid to see the dentist because it’ll hurt.”  It really doesn’t make sense because their teeth is hurting now but they are afraid of going to see the dentist because it’ll hurt?  I’m sorry, I fail to comprehend the logic behind that statement.  The second point is that if you only visit the dentist when the pain has kicked in, it means the problem you have in your mouth is a big one and that means a big procedure will be necessary and big procedures, being more complex and more involved, can be painful (although I should add that in this day and age, most dental treatments can be done painlessly).  If you make regular trips to the dentist, your dentist will be able to fix the problems in your mouth while they are still little ones - these involve small procedures that are simple and painless.

I digress… I’m supposed to be talking about baby teeth.  Sorry.  I can’t help lecturing when I get on this topic… 

Cleaning Baby’s Teeth

You can get finger brushes that you can wear over your finger and use that to brush baby’s teeth.  It’s easier to use when compared to a toothbrush but it really depends on your child’s compliance.  In theory it sounds great but when I got one for Gavin, he refused to let me clean his teeth.  In the end, I ended up using a wet washcloth to rub his teeth, which he seemed to like.

Young children don’t need fluoride toothpaste, especially if you live in an area where the water is fluoridated.  Because of their small stature, it is easy for children to get too much fluoride which can cause a condition called fluorosis.  Mild fluorosis appears like small white spots on the teeth.  In severe fluorosis, the teeth can become brown and mottled - although there is nothing wrong with the teeth, it is aesthetically rather unpleasing.

When you start introducing fluoridated toothpaste to a child, make sure you use children’s toothpaste which usually only has about 500ppm of fluoride (compared to regular adult’s toothpaste which has 1000ppm of fluoride).  Make sure you put only a pea size amount on your child’s brush and mash it into the bristles so that your child doesn’t end up swallowing the toothpaste.  Young children have difficulties spitting so often they end up swallowing most of the toothpaste which increases their fluoride exposure.

There are really only two major diseases that affect the teeth and gums - dental caries (tooth decay) and gum disease.  When you brush your teeth, the fluoride in your toothpaste protects your teeth from dental caries and the brushing action of your toothbrush protects your gums from gum disease.  It really is as simple as that.  The fluoride in toothpaste attaches itself to the tooth surface forming a new harder structure that is more resistance to dental caries.  The action of toothbrushing removes plaque bacteria that accumulate around the teeth and irritate the gums, causing gum disease. 

In Uni, one of my lecturers explained to us that for some reason currently unknown to us at that time, children have a natural protection against gum disease.  They are immune to gum disease - perhaps it is just mother nature’s way of protecting our children, who knows? Once they turn 6, they are no longer protected, because at 6 years, the first adult molars will erupt into the mouth. 

So when it comes to your baby’s teeth, all you really need to concern yourself with is dental caries.  Which leads me to another concern that I had earlier when I had decided I was going to try to continue nursing Gavin at least until he turns 2 (as recommended by WHO, 2002).  Since Gavin is so active during the day, he tends to nurse a lot at night and since the flow of saliva is reduced when we sleep, I was concerned that the milk sugars left in his mouth might lead to tooth decay.  During the day, the constant flow of saliva washing over the teeth helps to protect the teeth from decay.  Since it would be impractical to clean Gavin’s teeth after each time he nursed, I wasn’t sure what to do about it until I read the chapter on nursing toddlers in The Womanly Art of Breastfeeding.

It appears that the milk sugars in breastmilk seem to have a lesser effect on causing tooth decay compared with formula milk and that “prolonged demand breast-feeding does not lead to a higher caries prevalence” (Weerheijm et al, 1998).  From the study, only 9% of the children who received prolonged demand breast feeding suffered from nursing caries and this was due to their low exposure to fluoridated toothpastes.  For mothers whose babies are more proned to tooth decay, it was recommended that they clean their toddlers’ teeth more frequently during the day time, especially if their toddlers are night nursers. 

Now I can continue nursing Gavin at night without feeling guilty…

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There are two schools of thought when it comes to teething - the one that believes that teething symptoms are just incidental and unrelated, and the one that believes teething can cause irritability, loss of appetite, diarrhoea, and fever.  Gavin’s paediatrician belongs to the school of the former and I was quite happy to be agreeable except that Gavin seems to be displaying classical teething signs that can’t be ignored.

He’s been irritable, cranky and crying a lot more than often (and I cannot relate any of this to any of the wonder weeks - even the hubby has started to joke about it being a wonder year); he doesn’t want to eat (not even cheese which is his favourite food and he never refuses it until now); he’s had diarrhoea on and off despite that fact that we have eliminated all suspect foods from his diet; and he’s had a bit of a sniffle.  While all this was happening, a little pearly white pops up from the surface of his gums.  Coincidence?  Well, it gets harder and harder to believe when it happens twice.  Another Mom - D also said that every single time S grew a new tooth, she would get the sniffles.

I’m afraid I have to go with the school of thought that teething symptoms do indeed exist…

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At ten months and one week, Gavin is finally cutting his first tooth!  Although he won’t let me get a look at it, I felt it a couple of nights ago while I was nursing him.  I felt something sharp scraping my nipple as he suckled.  When I felt his lower gum, sure enough, there was a jagged edge embedded the gums.  I guess it is only a matter of time now before he’s chomping his way through more food.  I’ll bet Ah Kong and Ah Mah will be delighted because the presence of teeth opens up a whole new complement of foods that Gavin will be able to tuck into.

Although the doctor told us that babies feeding shouldn’t be affected by teething, it certainly feels as though Gavin wants to nurse more over the last couple of days.  He also seems to be less interested in his bread.  Although he still eats it, he doesn’t devour it as eagerly as he did prior in the previous couple of weeks.  Another Mummy friend of mine also said that she found her daughter was mildly ill every single time she was teething despite the doctor saying that there was no link between teething and being ill.  Well, I suppose these are just one of those gray areas in medical science that is neither proven nor disproven because of the great disparity of experiences among teething babies.

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This is another one of those privileges of being a grandparent that I wrote about in an earlier post.  Anyone who knows me well enough has probably heard me repeating myself like a broken record that the taste for sweetness is a learned response.  Babies don’t crave sweet things until their tastebuds are trained to take it.  Because of this, I have been guarding Gavin’s mouth like a hawk to make sure that nothing goes in that will cultivate unhealthy eating habits becuase I don’t want to have to deal with an infant who will only eat junk food.  Neither do I want to end up like the parents my paedodontic lecturer once told me about when I was studying dentistry back in University. 

My lecturer was not a particularly pleasant man and he would be rather scornful as he recounted how parents would come to him crying over the rotting black stumps for teeth that were in the mouths of their children.  These children would end up having mouthfuls of crowns (if they were lucky) or full dentures (if they weren’t) because the abscesses in their mouths required such drastic treatment.  Because the treatment was so drastic, they would have to go under a general anaesthetic for treatment.  The children who had to have full dentures were because they weren’t old enough for their adult teeth to erupt.

If you think I’m trying to scare you, well, I am.  But the scenario I’ve painted is very real if you don’t take care of your child’s teeth.  A lot of parents have this misconception that baby teeth aren’t important and often don’t see the need to take their children to the dentist.  After all, the teeth are going to fall out eventually and the adult teeth will come into place, right?  Yes, that’s true, to an extent.  Each adult tooth has a designated time when it is ready to erupt into the mouth.  If a baby tooth is lost before the adult tooth is ready, there will be a gap present until the time the adult tooth is scheduled to erupt.  So until the adult tooth is ready, that baby tooth serves as a place holder for that adult tooth.

I digress - this wasn’t supposed to be a lecture about teeth.  It’s a post about ice cream.  So how on earth did Gavin get his first taste of ice cream since I’m so anal about keeping him off the junk food? 

I think it is the grandparents’ want in life to spoil their grandchildren.  This fact is as eternal as the rising sun and no parent can escape it.  Last Sunday, the hubby and I went for dinner with my MIL and FIL.  As usual, I was the last to finish dinner because I would be occupied with feeding Gavin.  And as usual, Gavin would fuss to be out of the chair before I would be done with dinner and his grandparents would kindly take him for a walk while I finished my dinner.  When asked whether they wanted dessert, my MIL and FIL declined. 

After we had paid for the bill, the hubby and I went to look for the three of them and we spotted them huddled outside Baskin Robbins looking highly suspicious.  When they spotted us approaching, I swear they looked as guilty as a kid caught with his hand in a cookie jar.  Although my FIL pretended that he was feeding ice cream to my MIL who had her arms full carrying Gavin, both the hubby and I knew better.  Gavin’s tastebuds were no longer innocent to the taste of ice cream.  I guess I can only be grateful that they stuck to plain vanilla ice cream.

Below: Gavin with Ah Mah and Ah Kong during Ah Kong’s birthday.

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