Do I Have to Stop Night Feeding?

At our 12-month well child check for our son, our pediatrician advised me to stop breastfeeding at night because of the risk of cavities. We bed-share, and my little one spends most of the night attached to my boob. I know it’s not necessary at this point and it’s just a comfort habit. Is there any research about the risk of breastfeeding at night for baby teeth?

—Still night-nursing mama

There is some data on this, and it does reflect your pediatrician’s advice. Perhaps the most comprehensive place to look is this 2015 meta-analysis that looks at the relationship between length of breastfeeding and cavities (or “dental caries,” as they are called in the literature). The researchers find limited relationship between breastfeeding for less than 12 months and dental caries, but they do see increased risk of caries when they compare children who are breastfed for more than 12 months and, especially, when breastfeeding is continued at night. The estimates suggest a risk about seven times higher for children older than 12 months who are nursing at night.

The studies here are not randomized trials, so we do worry about confounding variables. In this case, many of those variables are likely to push in the other direction — extended breastfeeding tends to be associated with more income and education, which is in turn associated with lower engagement in other behaviors that lead to cavities (like sugary beverage consumption). Additionally: there is a clear physical mechanism by which the behavior of nocturnal nursing may lead to cavities. Cavities are more likely to occur when sugar stays on teeth for longer. When a child falls asleep with the nipple in their mouth, their tongue can effectively trap the milk on their teeth, which raises the cavity risk.

This is all to say that, yes, there is some data behind what your pediatrician says.

Does this mean you should stop nursing at night? I do not know! The cavity risk is a reason to stop, but there are other reasons you might want to continue. As I will often say: data isn’t bossy. These data will not tell you what to do, but they should be an input to your decision.