Promote Healthy Habits in Child Care – Toothbrushing

Tooth decay is the number one chronic disease that affects young children and is five times more common than asthma. Untreated, tooth decay can cause pain and infection, resulting in children who stay out of care and experience problems with eating and speaking. Dental decay (also known as dental caries) can affect children’s concentration and learning. Twenty percent of children between five and eleven years of age have at least one untreated, decayed tooth. Children from low-income families suffer from twice as much untreated tooth decay (25%) as children from higher income families (11%). (CDC 2014) Yet tooth decay is easily preventable. Regular dental habits such as toothbrushing and a healthy diet can reduce the occurrence of cavities greatly. To be most effective, both should be part of a child’s routine at home and at his early care and education program. Additionally, adults in the child’s life should model good oral health practices and participate in routines with the child.

Support oral health in your program

Develop an oral health policy

To support oral health in early care and education (ECE) programs, the American Academy of Pediatrics encourages programs to include oral health as part of an overall health plan to support preventive care for young children. The goal of the plan is to meet individual children's needs by sharing information between families and the program, and to ensure that the program follows good health practices.

Serve foods that support oral health

To promote oral health, follow nutrition guidelines for young children. Serve a variety of fresh fruits and vegetables and include calcium- and protein-rich foods to build strong teeth. Give children water to drink between meals and with snacks.

Be aware of natural sugars in food. For example, raisins are a healthy snack, but can stick to children's teeth. If natural sugars sit on teeth, it can cause tooth decay the same as refined sugars. Eat raisins with other foods to help remove bits of food from teeth. Fruit juices are also high in natural sugars.

Limit the amount of fruit juice:

  • No fruit juice for infants up to one year old.
  • No more than four ounces of fruit juice per day for toddlers, one to three years of age.
  • No more than four to six ounces of fruit juice per day for preschoolers, four to six years of age.
  • No more than eight ounces of fruit juice per day for children age seven and above, youth, and adults.

(Heyman and Abrams 2017)

Make toothbrushing a daily routine

Children love to imitate other children and adults. When adults talk about healthy teeth and include toothbrushing in the daily routine, children are more likely to accept toothbrushing as a lifetime health habit. The proper way to brush teeth is a skill that young children need help to learn. Most children between the ages of three and six are able to brush their own teeth, but supervision is needed to make sure teeth are clean and that children don't swallow large amounts of toothpaste.

To support oral health, add toothbrushing to the daily routines, and brush after any main meal at the program, such as lunch or dinner.

Toothbrushes and toothpaste

Each child should have an age-appropriate toothbrush with soft bristles labeled with his name. Medium and hard toothbrush bristles can damage the gums and teeth. Children's toothbrushes are made in different sizes. Toothbrushes for infants and young toddlers have a very small brushing head with extra soft bristles. As a child's mouth grows, she needs a larger toothbrush.

Toothbrushes should be replaced every three months or more often if the bristles look frayed or worn. A child's toothbrush should also be replaced after a child has been ill with a cold, the flu, or an infection.

Use fluoride toothpaste. Choose a mint flavored toothpaste with fluoride. Fruit or candy flavors encourage children to eat the toothpaste. It is also important to know if a child has any possible allergies to ingredients or additives in toothpaste. Toothpaste should always be stored in a locked cabinet and out of children's reach. Adults should be responsible to access and distribute toothpaste to the children.

Store toothbrushes safely

After children finish brushing their teeth, rinse toothbrushes with water. Allow toothbrushes to air dry, and store them so they do not touch or drip on one another.

Organize toothbrushing

Develop a transition flow of activity so that toothbrushing is a part of the lunch-to-nap transition with minimal waiting time. As children finish eating and clean their spaces at the table, they can go to the toothbrushing area, then go to activities. Meal, activities, and toothbrushing areas need to be supervised at all times.

If there is not a sink in the classroom or a connected bathroom, groups of children can take turns going to the bathroom with a staff member for toothbrushing. Engage waiting children: play games, sing songs, tell a story, do simple movement activities.

In a family child care home, the bathroom is often located away from the child care area so children have to go to the bathroom as group for supervision. The provider should stand where she can see all the children, those waiting outside the bathroom and the children in the bathroom. Incorporate activities for the waiting children: sing songs together, tell a story, provide toys.

Bathrooms in family child care homes are often shared spaces. To follow all health and safety regulations, and to have all child care items accessible within the bathroom, providers may need to move materials in and out the bathroom daily for child care routines and family use.

For more ideas on how to support children's oral health, check out the Better Kid Care module "Oral Health for Young Children: Promote Healthy Habits in Child Care."

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Promote Healthy Habits in Child Care – Toothbrushing

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