Bottles and pacifiers: advice from a Latinx pediatrician

Growing up in Puerto Rico, “babas” (bottles: biberón/botellas) and “bobos” (pacifiers:  chupetes/chupón) were very common among the families and children of the island.  I still remember our Abuelita giving us milk in our “babas,” so my younger sister and I were sure to fall asleep better.  From the time of our births, to when my sister was three years old, the “bobo” was also consistently being used in our home.

Now, as a pediatrician, one of the conversations I have most frequently with my Latino families is regarding the proper use of both “babas” and “bobos” for their children.  Were you aware that children should begin using training cups (commonly referred to as “sippy cups”) as early as nine months of age?  It is also very important that your child gradually ween off the use of bottles between the ages of 12 to 15 months.  Continued use of bottles after one year of age has been repeatedly documented to increase the risk of tooth decay in children.

I’ve also noticed that when children continue to use bottles beyond their first year of life, there is a tendency to serve them more cow’s milk than needed in their diet.  It is important to remember that cow’s milk is not the same as breast milk or formula and does not possess the same vitamins or nutrients.  When your child drinks too much cow’s milk (more than 16 to 24 ounces a day, or more than three cups), they may develop iron deficiency anemia, constipation, and have the potential to gain too much weight too quickly.  Children, like adults, need to eat vegetables, fruits, protein, and grains to maintain a balanced diet.  Children who are older than a year and drink too much milk are less likely to have the appetite to eat the foods they need to grow. They can often feel “full” after drinking the milk but aren’t consuming nutritious food.

When using bottles for children under one year of age, please do not let your baby fall asleep with the bottle in their mouth, because sugar in the breast milk or formula can cause tooth decay.  Also, please don’t put juice or soft drinks in a bottle, because juice has high quantities of sugar that isn’t necessary for your baby’s diet, greatly increasing the risk of your child developing tooth decay at an early age.

The American Academy of Pediatrics recommends not to give juice to babies under the age of 12 months.  Juice decreases your baby’s appetite and can lead to diarrhea, diaper rash, and a higher chance of excessive weight gain.

Pacifiers are also best for infants, especially newborns, and can be used during the first six months of life.  After six months and before turning one year old, the American Academy of Pediatrics recommends removing the pacifier to reduce the risks of ear infections, dental problems, and speech delay.  If your child is older than one year, be sure to gradually eliminate the pacifier / “bobo” from their daily routine.

If you are having difficulty curtailing or eliminating the use of bottles or pacifiers, please consult with your pediatrician or health care provider.  Your pediatrician will help you adopt healthy habits for your family.  Babies should have a physical examination when they are born and then also at 1, 2, 4, 6, 9, and 12 months of age.  After 12 months (first birthday), children require physical exams at 15, 18, 24, 30, and 36 months of age.  After turning age 3, your child needs to return to the pediatrician once a year for his or her annual routine physical exam (sometimes referred to as a “well-child visit”).  Also, don’t forget to take your baby to the pediatric dentist as soon as their first teeth emerge and then follow up with routine dental visits every six months regularly.

Growing up and growing out of the use of bottles/”babas” and pacifiers/”bobos” is a normal part of your child’s development, but they never grow too old for consistent, quality health care.  Please help your pediatricians provide the best care for your children by taking the best care of them at home.

Johanna Vidal Phelan is a pediatrician.

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