A parent asks: Our child is in elementary school. Despite our efforts to encourage her to have fun with brushing her teeth, she doesn’t and never has enjoyed it.
At school, they say she tolerates it. At home we’ve used visuals, the toothbrush song video on YouTube, etc. but her experience hasn’t improved. It gets to the point where you feel as a parent you are deliberately hurting your child.
We’re deeply concerned that it will get to the point of causing significant health problems.
Ellen answers: This is a problem many parents find both vexing and wrenching, with good reason: tooth decay can progress to infection, which can cause problems with the jaw, sinuses, brain and even heart. Fortunately, this worrisome puzzle has many possible solutions. Before we get to those solutions though, I would suggest reframing the challenge. Your child doesn’t have to enjoy or have fun with brushing. She only has to understand that cleaning her teeth is a have-to, and that it will result in her feeling better overall. Help her understand that it has to be done, but the manner, timing, products used, and other variables are numerous and that you are there to help her try as many things as it takes to find a way with which she can be comfortable. You’ll find several dozen ideas farther on here.
But first, the main thing that jumps out at me is that she tolerates brushing at school but not at home. While it is not unusual for children to exhibit very different behavior at school than at home, the fact that she brushes at school strongly suggests that there may be some factor that’s different than at home. It may be something that seems small and insignificant to you but makes or breaks the experience for your child.
Meet with your child’s teacher and go over every single aspect of her brushing experience at school, down to the tiniest thing. My guess is there’s a sensory or social factor that’s different from at home. Some possibilities: different toothpaste or maybe no toothpaste, difference in water temperature (she may tolerate warm water but not cold), toothbrush with different grip, head or overall size, presence or absence of a mirror, less time pressure at school (is she rushed in the morning or very tired at night when asked to brush at home?), does she have a peer buddy at school that helps or encourages her, does she get to do something she likes doing following brushing, does she have some sort of timer that lets her know when it will be over? If you can observe or learn exactly how brushing happens at school, you may be able to detect something you haven’t tried at home.
And this may seem obvious, but have you asked her why she resists brushing at home but not at school? She may not be able to tell you directly, so you may have to probe a bit, or perhaps get her to express it differently, such as through drawing, acting, or showing you a picture on a device. Teasing out the reason may unfold over a period of days.
Here are more ideas, from my book co-authored with Veronica Zysk, 1001 Great Ideas for Teaching and Raising Children with Autism or Asperger’s, revised and expanded edition (2010), Chapter 4, Daily Living:
You don’t have to brush all your teeth, our dentist tells us—only the ones you want to keep. Oral defensiveness can make it hard for a child to tolerate foreign objects, or invasive tactile or gustatory (taste) sensations in his mouth. Tooth brushing can be an ordeal for such children, but it is essential to good health.
- Remember that the purpose of brushing is to remove bacteria, and a toothbrush is just a tool for doing that. It’s not the only tool, and there is no one right toothbrush. You can try:
- Shaped and angled toothbrushes
- Heads of various shapes
- Soft, medium or firm bristles (most kids – and most dentists — prefer soft)
- No brush at all. Use a piece of gauze or washcloth wrapped around a finger. Dip it in toothpaste, fluoride wash, or just plain water if that’s all your child will tolerate. You’ll still be removing a large amount of bacteria.
- A battery-operated toothbrush. Many children find the vibration soothing, although some find it irritating.
- Adaptive toothbrushes such as the Nuk toothbrush trainer (rubber latex brush) or Nuk massage brush, or the Collis-CurveTM Toothbrush, which brushes on all three sides at once. Another is the sixty-second TimeMachine Toothbrush, a timer toothbrush that brushes front, back and chewing surfaces of both upper and lower teeth at the same time.
- Brush with warm water to reduce sensitivity.
- Experiment with consistencies and flavors of toothpaste. Paste may be too gritty but gel may be just right. And remember that proper brushing technique is much more important than whatever toothpaste you choose. As one hygienist put it: “It’s the brushing that does the work, not the paste. Don’t fight toothpaste battles. The flavor and foaminess are often more about your adult preferences than your child’s.”
- If your child is sensitive to food dyes, artificial sweeteners and other substances, be aware that many common-brand toothpastes contain such ingredients. The FDA does not require toothpaste be labeled as such, but if the paste has stripes, blue speckles or a pink glow, you can bet it contains dye. Visit health food stores for natural herbal toothpaste options. Many, such as Auromère, contain ingredients from the “toothbrush trees” – neem and peelu.
- If brushing all the teeth at the same time is too overwhelming, break it up. Brush just the bottoms, take a two-minute break (or five or ten), then come back and brush the tops. Break down further as needed.
- Sing a short song with each section as a way of letting your child know how long it will take. Suggestions: “Bingo,” “Farmer in the Dell,” “Old McDonald,” “Down by the Bay,” “Five Little Ducks,” “Row, Row, Row Your Boat” or “Twinkle Twinkle Little Star.”
- Post a visual chart illustrating each step of the tooth brushing process to help build independence and self-esteem.
- Most young children will need your assistance to achieve the proper angle and motion for effective cleaning. Stand behind your child to help, as the dentist does. Let him rest his head against you. Letting him sit may make it easier. Teach him to hold the brush along the gum line at a 45° angle and move the brush in small circles, not up and down. Understand that you may be assisting your child with this up to as late as age 10. Many children will not have the necessary manual dexterity until that age.
- Follow up tooth brushing with a pleasant, anticipated activity (such as reading together or listening to music).
1001 Great Ideas for Teaching and Raising Children with Autism or Asperger’s (2010) is the winner of the Independent Book Publisher Awards Silver Medal, Mom’s Choice Gold Award, and Learning magazine’s Teacher’s Choice Award.
“Genuine, commonsense advice that all parents and educators can quickly and easily use.” ~ Temple Grandin, Ph. D.
© 2017 Ellen Notbohm
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