Association Between Night Feeding and Early Childhood Caries in Infants and Toddlers

Early childhood caries (ECC) remains a common oral health problem among infants and toddlers, with feeding behavior playing an important role in the conditions that favor its development. Night feeding has received particular attention because feeding during sleep occurs when salivary flow, swallowing frequency, oral clearance, and buffering capacity are reduced. Frequent or prolonged exposure of erupted primary teeth to breast milk, formula, cow’s milk, or sugar-containing beverages may provide fermentable carbohydrates for dental biofilm and extend periods of acidic challenge. The association is influenced by the frequency and duration of nocturnal feeding, age of the child, tooth eruption, type of feeding, complementary dietary practices, fluoride exposure, and oral hygiene. Caries development reflects an ecological shift within the dental biofilm, where repeated carbohydrate exposure favors acidogenic and acid-tolerant microorganisms. Organic acid production lowers plaque pH and promotes enamel demineralization, while reduced salivary activity during sleep limits clearance, buffering, and remineralization. Persistent night feeding may therefore become more relevant to caries risk as children grow older, more primary teeth erupt, and feeding is combined with dietary sugars and inadequate plaque removal. Breastfeeding itself should not be regarded as an isolated cause of ECC, given its established nutritional and developmental benefits and the multifactorial nature of dental caries. Clinical assessment should instead consider the complete feeding pattern and its interaction with established caries risk factors. Preventive measures include caregiver-assisted brushing with fluoridated toothpaste following tooth eruption, limitation of added and free sugars, avoidance of sugar-containing bottles during sleep, individualized feeding counseling, early dental attendance, caries-risk assessment, and professional fluoride application when indicated. Recognition of nocturnal feeding patterns within routine infant oral health assessment may allow potentially harmful combinations of dietary exposure, inadequate oral hygiene, and limited fluoride protection to be identified during the earliest stages of primary dentition development.