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Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program
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Anticipatory Guidance by Age
For children younger than 6 months:
Strongly encourage breastfeeding
Counsel parents on methods of delaying colonization with cariogenic bacteria.
Delay introduction of juice, preferably until 1 year of age or not at all.
Recommend juice from a cup only, never from a bottle.

Late Infancy
For children 6 months to 1 year of age:
Counsel parents to begin brushing with a smear (grain of rice amount) of fluoride toothpaste once teeth erupt.
Provide anticipatory guidance on teething care. (Refer to Chapter 2: Dental Development > Teething Care and Anticipatory Guidance for more information.)
Counsel parents that infants should be held when bottle-fed.
Bottles should not be propped with infants in cribs or car seats.
Introduce a cup as soon as the infant can sit unsupported (around 6 months of age).
Try to eliminate the bottle by 1 year of age.
Begin fluoride supplements at 6 months if drinking water is non-fluoridated. (Refer to Chapter 6: Fluoride for more information.)
Provide dental referral around 12 months (approximately 6 months after eruption of the first tooth), especially if risk factors are present.
Provide dental referral 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.)
Fast Facts
Parents of infants should be counseled to begin brushing once teeth erupt.
Recommend that families discontinue bottle use by 12 months of age.
Parents of toddlers should be advised to limit sippy cup use and to keep snacks to one time between meals.
Cariogenic snacks should be limited for all children, with fresh fruit, vegetables, and whole grains being the snacks of choice.
Chapter Photo Gallery
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