Sir, further to the recent excellent letter in the BDJ (BDJ 2018; 224: 917), I would like to add a couple of points relating to the British Society of Paediatric Dentistry (BSPD) position statement on infant feeding,1 the summary of which featured in your publication earlier this year.

Whilst there is some evidence to suggest breastfeeding beyond 12 months may be cariogenic,2 this is not conclusive and the possible mechanisms for this are not fully understood.

There are also many confounding factors and individual differences, which haven't been controlled for in most studies to date.

In addition, the paper by Peres et al. cited by the BSPD, clearly states that 'breastfeeding between 13 and 23 months had no effect on dental caries' and the risk only increased when feeding for 24 months or beyond.3 Therefore, I cannot see how this justifies the BSPD viewpoint that on demand and nocturnal feeding should be reduced after 12 months.

Breastfeeding has many benefits to both mother and baby, and the dental community should be supporting this method of infant feeding, especially when breastfeeding rates in the UK are so low. It is estimated that less than 1% of infants in the UK are breastfed at 12 months4 so we are also targeting such a small number of the population with this advice, ignoring the overwhelming health benefits in the process.

I'm concerned that this guidance not only goes against WHO recommendations using inconclusive evidence, but risks undermining feeding practices.

Whilst I welcome clarification of the public health messages we should be giving our patients, I do not feel the information the BSPD are giving is accurate or particularly realistic, and I would therefore hope they consider altering their advice accordingly.