Feeding Issues & Toothbrushing - 10 Tips to Help

Toothbrushing: Who, What, Where, When, Why, & How

I am not a dentist. I’m a Feeding Therapist, so when I ask parents to add toothbrushing to their child’s daily routine, it’s less to do with tooth care and more to do with feeding development.

Many families I have worked with over the years have been advised by a dentist to hold their child down and forcefully brush their teeth. As a Feeding Therapist working with children with severe sensory issues and oral aversion, I do not practice or recommend this approach. I believe that positive toothbrushing experiences support feeding progress and development.

Why?

Toothbrushing is good for your child’s oral health and an essential component of his/her general health. From a feeding perspective, kids that can tolerate mouth stimulation like toothbrushing are generally better able to handle mouth stimulation like food. Toothbrushing supports feeding development. When children can tolerate toothbrushing, they are often ready to participate in accepting new foods and textures. Toothbrushing reduces oral hypersensitivity and helps to move the gag reflex further back in the mouth. It provides stimulation and input to the biting and chewing surfaces as well as the lips and tongue. These are the same structures that are used during eating.

Parents often report that toothbrushing is a tremendous challenge and that they are not able to brush their child’s teeth. This is common in children with a history of negative oral experiences or sensory issues impacting their feeding. Stimulation in the mouth can be overwhelming, negative, and may trigger gagging.

When?

The beginnings of toothbrushing emerge in infancy when your baby participates in oral exploration of his/her hands and toys. Many children with medical issues, developmental delays, and/or sensory differences avoid or miss out on mouth stimulation from a very young age. It’s important to encourage your baby to bring hands and toys toward his/her mouth in a positive, child-directed way.

Some children, especially those with sensory processing issues and Gastroesophageal Reflux (GERD) do not tolerate toothbrushing well in the morning. They are more likely to gag. I suggest starting with choosing two times per day to introduce toothbrushing. Once during the day and once before bed. Ideally, kids should participate in mouth care after eating; however, some children will initially gag when toothbrushing is introduced, which may cause them to vomit their meal. When starting, try practicing toothbrushing away from mealtimes. It’s important to be consistent and keep the routine in place every day. Repetition really helps.

Who?

Both you and your child can be active participants in toothbrushing. As mentioned, encourage your baby to participate in mouth stimulation by guiding his/her hands toward the mouth. If your child is unable to grasp toys due to developmental delay, you can use hand-over-hand assistance and hold the brush together and bring it toward your child’s mouth.

For toddlers and older children, make toothbrushing a family affair! Everyone can brush their teeth together. I suggest allowing your child to brush their own teeth, paired with helping them. You can use a turn-taking, “your turn” - “my turn” approach to brushing your child’s teeth. Your child learns by watching you!

What?

I am often asked which toothbrush to use for kids. There are many great options for mouth stimulation and toothbrushing and all children are different. What works for some kids doesn’t necessarily work for others.

As a first toothbrush, I recommend a soft, infant wash cloth for massaging and wiping baby’s gums. As baby gets older, you can progress to the Infa-Dent Soft Finger Toothbrush & Gum Massager and continue providing routine touch on the lips, gums, and tongue.

For older infants and toddlers, I frequently recommend the Baby Banana brush. The banana peel acts as a lip-block, which helps kids to avoid gagging themselves during brushing and oral exploration. When children are older, they can move toward a soft bristled brush, as found in stores. Many toothbrushes are cleverly designed with themes and kids’ favourite characters. Some kids really like toothbrushes that vibrate. I encourage parents to take their child to the store and let them choose their own toothbrush, so they are involved in the process.

Parents often ask me if they should use toothpaste. I typically recommend starting with just water on the brush, as most of the children I work with experience sensory overload if they are presented with oral stimulation/brushing paired with a new taste at the same time. Toothpaste can be introduced once the child is tolerating the sensation of brushing.

Where?

When my kids were little, I would always brush their teeth in front of a mirror so they could see what was happening to them. I would sit them on the bathroom counter, stand behind them, and they would lean against me while facing the mirror. Introducing toothbrushing in the bath can also work well. If you child likes playing in the water, you can offer a cup/bowl of fresh water and play with the toothbrushing while splashing and stirring the water.

How?

Don’t force. Many children with feeding issues have a history of negative oral experiences due to their medical history (e.g., tube feedings, prematurity, GERD, breathing support, etc). They are fearful of things going into their mouth, because they associate this with pain and discomfort.

I believe that it is contradictory and confusing to teach parents to practice positive, child-directed feeding strategies while they are forcing toothbrushing. In order for children to learn to enjoy eating and food, then need to learn to trust that their mouth is a positive place. How can the child trust a parent bringing a spoon of food toward their mouth when that same parent has been advised to hold them down and push a toothbrush into their mouth?

10 tips to make toothbrushing more positive:

1. Start by just having the toothbrush around so it becomes familiar.
2. For older kids, let them choose their own toothbrush with a favourite theme.
3. Brush your teeth alongside your child.
4. Watch kids' YouTube videos about toothbrushing.
5. Brush dolls', dinosaurs', and teddy bears' teeth.
6. Play music or sing a toothbrushing song.
7. Use a mirror.
8. Start with water and water play.
9. Allow your child to hold the toothbrush and have control.
10. Baby steps…you don’t have to start with the teeth!

Baby steps…

Make it fun! I utilize Marsha-Dunn Klein’s (OT) “Toothbrushing 1-2-3©” approach (see references). It works extremely well! For many children, I start with touching their hands and arms with the toothbrush. I tap the brush while counting 1-2-3, then make the toothbrush fly “Awaaayyyy!” This is repeated several times. Once the child becomes comfortable, I work upward, tapping the shoulders, then cheeks…while counting “1-2-3 Awaaaayyy!” Over time stimulation is introduced on the lips, the front teeth, side teeth, back teeth, and eventually the tongue. The brushing is provided in short intervals while always counting to 3 then taking the brush away to provide the child with a beginning and an end. When first introducing this approach, count quickly, so the duration of stimulation is very short. As the child develops tolerance, continue counting to 3, but slow down your counting, so the duration of toothbrushing becomes longer. Never go beyond the count of 3 or you will lose the child’s trust…instead just slow down your counting.

In time, children can gradually develop an increased acceptance for mouth stimulation and toothbrushing. Parents frequently tell me that once their child started tolerating toothbrushing, they observed a marked improvement with feeding. Chewing may improve as a child is able to tolerate input on their teeth and biting surfaces. Acceptance of food textures may improve as gagging reduces, your child’s mouth muscles develop, and they are better able to handle different sensations in their mouth. Start early, be consistent with a daily routine, and most importantly use a child-directed, positive approach to toothbrushing.

Disclaimer: This blog is not meant to replace advice from a Dentist. The information is provided to help families of children with feeding disorders and oral/feeding aversion. Please visit The Canadian Dental Association for additional information regarding dental care guidelines for children. FeedingPlus Inc. does not earn a commission from the sale of any of the products mentioned.

References:

Marsha Dunn-Klein, OTR/L, MEd, FAOTA: https://www.getpermissionapproach.com/articles

The Canadian Dental Association: http://www.cda-adc.ca/en/oral_health/cfyt/dental_care_children/cleaning.asp