Health Promotion and Maintenance Q 105
The mother of a 14-month-old child reports to the nurse that her child will not fall asleep at night without a bottle of milk in the crib and often wakes during the night asking for another. Which of the following instructions by the nurse is correct?
A. Allow the child to have the bottle at bedtime, but withhold the one later in the night.
B. Put juice in the bottle instead of milk.
C. Give only a bottle of water at bedtime.
D. Do not allow bottles in the crib.
Correct Answer: C. Give only a bottle of water at bedtime.
Babies and toddlers should not fall asleep with bottles containing liquid other than plain water due to the risk of dental decay. Wean one ounce a night. Let’s say the child takes three 4 oz bottles a night. Take the last bottle and reduce it by an oz on night one. On night 2, reduce bottle 2 by 1 oz. On night 3 reduce Bottle #1 by 1 oz. When a bottle gets down to 2 oz, substitute a bottle of water. After this step, get rid of the bottle. Don’t ever wake up the child if they sleep through a feeding– that is the goal.
Option A: If they skip a feeding one night but wake up the following night for that feeding, it is OK to give them the scheduled bottle. Limit the water bottles to 2 oz, simply to reduce the amount of urine produced and wet diapers to deal with. If the child doesn’t want the water, that is fine. But don’t give in and give the milk.
Option B: Sugars in juice remain in the mouth during sleep and cause caries, even in teeth that have not yet erupted. Make slow incremental changes over time. These changes are relatively easy to make and the child will tolerate them well.
Option D: The child could have a bottle of water in the crib with close supervision. Bottle fed infants typically can wean off night feeding by 6 months of age. Breast fed infants tend to take longer, up to a year of age. The American Academy of Pediatrics recommends exclusive breastfeeding for six months, with the addition of complementary foods continuing up to a year, or longer “as desired by mother and infant”. It’s important to note that night weaning can lead to weaning altogether.