Sweet tooth

You can’t have missed the headlines last week about children’s dental health. A survey by government agency, Public Health England, found that on average 12% of 3 year olds have suffered dental decay. Rates were particularly high in Leicester, at 34%.

The BBC stated that “Researchers also said that some children had a particular type of decay known as early childhood caries. This affects the upper front teeth and spreads quickly to other teeth. It is linked to the consumption of sugary drinks in baby bottles or sipping cups.”

It’s interesting that they didn’t mention the increased use of puree pouches. Dentists have previously raised concerns about infants sucking the puree directly from the pouch. This also puts their front teeth in contact with more of the puree than spoon-feeding and so could also be a contributing factor to tooth decay, if consumed in this way regularly.


Unfortunately pouches like the ones in the photo do not include recommendations on the packaging stating that they should not be sucked directly from the pouch but served in a bowl.*

Sweet treats

The best way to limit tooth decay is to limit sweets and sugary foods. It’s as simple as that, and everyone knows it. But it can be hard in a culture where sweet treats have become an every day occurrence, to swim against the tide.  Overwhelmingly the foods that are promoted to children – be it Cheerios, Frosties, Penguin bars, Haribos, or Ribena – are high in sugar. Parents get blamed if their children are overweight or have tooth decay. The buck stops with us. But our efforts to get our children to eat healthily are undermined by food industry promotions.

If you give your child sweets or chocolate, smoothies or cake the ideal time is after their main meal, when their teeth are protected by the other foods consumed. It’s also recommended to drink water after eating something sweet to remove at least some of the sugars in the mouth. Drinking through a straw can reduce sugar coming into contact with teeth. Delaying brushing teeth until at least an hour after eating sweet food is also recommended to as tooth enamel is softened in the hour directly after consuming sugars.

Sugar in fruit

Of course, sugar doesn’t just come from sweets, chocolate, cakes biscuits and soft drinks.

Sugar in a whole unprocessed piece of fruit is inside the fruit cells – “inside” means intrinsic. Because they are held inside the cells they come into less contact with the teeth compared to extrinsic sugars. Fruit is therefore fine as a snack between meals as long as it’s not consumed excessively.

Yes you’ve guessed it – “extrinsic” means outside the cells. If you process fruit – whether it’s making a smoothie, pureeing, juicing or drying it, this changes the fruit structure so that sugar is released – becomes extrinsic and therefore comes into more contact with teeth. This means regularly consuming fruit in these forms in between meals leads to greater risk of tooth decay.

The term non milk extrinsic sugars refers to these sugars, and whilst sugar in milk is extrinsic, it doesn’t cause dental decay – which is why they’re called “non milk”.


Generally, the advice is to avoid giving sugary food and drinks including smoothies, purees, dried fruit, fruit juice and sugar sweetened milkshakes, between meals.

So that includes these dried fruit snacks (below) and similar types of dried fruit bars and strips. They contain concentrated sugars that stick to teeth. Basically if it looks and tastes like a sweet, even if it is made of 100% fruit, then treat it like a sweet.

Research from the British Dental Association has found that the acidity ph for smoothies was below 5.5, at which teeth are more likely to become eroded.


The best drinks to protect children’s teeth and health are water and milk. Fruit juice can be drunk at mealtimes, watered down so it’s half water half juice. But is not needed as an every day drink. If you are already giving juice, squash, sugary drinks or fizzy drinks to your children try and reduce gradually over time, with squash and juice you can gradually water it down so that it’s more water eventually and then switch over to water. Making changes to children’s diets that are gradual tends to works well.

Even sugar free drinks can be damaging to teeth if consumed between meals as they can be acidic. Also they are usually sweetened with artificial sweeteners, which are not recommended for young children. (Under EU regulations any weaning food or drink is not permitted to contain artificial sweeteners).

Never give a soft drink in a sippy cup or bottle as again, the sugars come into contact with teeth more. Advice is to give young children drinks from a free flowing cup.

Brushing teeth

Start brushing teeth morning and evening as soon as teeth appear. Reading a story at the same time, singing a song or getting them to brush their dolly’s or teddy’s teeth can help. Or brushing your own at the same time. If they’re old enough to appreciate stickers you could try using them as a reward. Your little one will get used to the routine. Also dentists recommend helping your child brush their teeth until they are 7 as they’re not able to get to all the nooks and crannies.

Ideas for healthy snacks

So having outlined what isn’t recommended, it’s only fair to give some examples that are recommended. Here are a few ideas of snacks, am sure there are lots of other ideas out there too… if you have any to share please post a comment as am always looking for ideas.

Here a few ideas off the top of my head:

Fruit of any kind (undried, not juice)
Vegetable sticks with or without dips like cream cheese
Cherry tomatoes cut in half
Home made plain popcorn (more for older children – as can be a choking hazard for younger children)
Bread roll
Bread sticks
Crackers with cheese
Unsweetened pancakes (I’ve adapted this recipe so it has no added sugar and relies just on the vanilla extract for sweetness)**
Rice cakes (spread with nut butter or cream cheese)
Handful of nuts (again for older children – they can be chopped into smaller pieces for younger children but not given to babies)
Crumpets with butter
Oatcakes (with cream cheese or butter)

Guidance on snacks for 1-4 year olds and 5-11 year olds has also been produced by Dr Helen Crawley when she worked at the Caroline Walker Trust.

Of course there are going to be times when your children have sweet things between meals, it’s really just about setting healthy eating habits for life so making everyday snacks healthy and breaking the rules every so often.

*They do suggest serving from a spoon or bowl. but ideally they should specifically warn against sucking directly from the pouch.

** If you’re making pancakes, use all the mixture and if you have left over pancakes, freeze them for snacks.