PACT: Preventive Care - Anticipatory Guidance by Age

Prenatal and Early Infancy (before 6 months of age)


		Strongly encourage breastfeeding
		Counsel parents on methods of delaying oral bacterial colonization.
		Delay introduction of juice, preferably until 1 year of age. Recommend juice from a cup only, never from a bottle.

Late Infancy (6 months to 1 year)


		Counsel parents to begin brushing once teeth erupt.
		Provide anticipatory guidance on teething care. (Refer to Chapter 2: Dental Development > Teething Care and Anticipatory Guidance for more information.)
		Do not sweeten pacifiers.
		Counsel parents that infants should be held when bottle-fed. If a bottle is given with anything other than water at nap time or bedtime, they should use a cloth to wipe the baby's mouth prior to laying the baby down.
		Bottles should not be propped with infants in cribs or car seats. Prolonged and frequent exposure to sugary liquids contributes to the caries process, and children who drink bottles while lying down may be more prone to ear infections.
		Introduce a cup as soon as the infant can sit unsupported (around 6 months of age) and try to eliminate the bottle by 1 year of age.
		Begin fluoride supplements in high risk patients at 6 months if drinking water is non-fluoridated. (Refer to Chapter 6: Fluoride for more information.)
		Provide dental referral:
			Around 12 months, especially if risk factors are present (6 months after eruption of the first tooth).
			As soon as possible if caries are identified or the patient falls into a high-risk category. (Refer to Chapter 3: Oral Health Screening > AAP Risk Assessment Tool or Chapter 4: Caries > Risk Factors for Early Childhood Caries for more information.)