Published online October 1, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. e944-e952 (doi:10.1542/10.1542/peds.2006-0124)
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ARTICLE

Association Between Infant Breastfeeding and Early Childhood Caries in the United States

Hiroko Iida, DDS, MPHa, Peggy Auinger, MSb, Ronald J. Billings, DDS, MSDa and Michael Weitzman, MDc,d

a Departments of Dentistry
b Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York
c Department of Pediatrics, School of Medicine, New York University, New York, New York
d American Academy of Pediatrics Julius B. Richmond Center of Excellence

OBJECTIVE. Despite limited epidemiologic evidence, concern has been raised that breastfeeding and its duration may increase the risk of early childhood caries. The objective of this study was to assess the potential association of breastfeeding and other factors with the risk for early childhood caries among young children in the United States.

METHODS. Data about oral health, infant feeding, and other child and family characteristics among children 2 to 5 years of age (N = 1576) were extracted from the 1999–2002 National Health and Nutrition Examination Survey. The association of breastfeeding and its duration, as well as other factors that previous research has found associated with early childhood caries, was examined in bivariate analyses and by multivariable logistic and Poisson regression analyses.

RESULTS. After adjusting for potential confounders significant in bivariate analyses, breastfeeding and its duration were not associated with the risk for early childhood caries. Independent associations with increased risk for early childhood caries were older child age, poverty, being Mexican American, a dental visit within the last year, and maternal prenatal smoking. Poverty and being Mexican American also were independently associated with severe early childhood caries, whereas characteristics that were independently associated with greater decayed and filled surfaces on primary teeth surfaces were poverty, a dental visit within the last year, 5 years of age, and maternal smoking.

CONCLUSIONS. These data provide no evidence to suggest that breastfeeding or its duration are independent risk factors for early childhood caries, severe early childhood caries, or decayed and filled surfaces on primary teeth. In contrast, they identify poverty, Mexican American ethnic status, and maternal smoking as independent risk factors for early childhood caries, which highlights the need to target poor and Mexican American children and those whose mothers smoke for early preventive dental visits.

Key Words: breastfeeding • early childhood caries • maternal smoking

Abbreviations: ECC—early childhood caries • S-ECC—severe early childhood caries • NHANES—National Health and Nutrition Examination Survey • dfs—decayed and filled surfaces on primary teeth • aOR—adjusted odds ratio • CI—confidence interval • IDR—incidence density ratio • FPL—federal poverty level

Accepted Mar 14, 2007.


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