Help, my child refuses to brush his teeth!

Credit: Envato

Dear Melissa,

I have a 4-year-old son with a diagnosis of Autism. He has extreme defensiveness to touch and food textures, and he gags easily. This oral sensitivity also makes brushing teeth a nightmare! He refuses to let me brush his teeth and refuses to brush them himself. I'm hoping that not brushing or flossing will be OK because he just has baby teeth. 

Following up from last week, yes baby teeth matter...a lot! To further respond to your question I'm again reaching out to Dr. Karen Green, a Board Certified Pediatric Dentist at Pediatric Dental Associates and Orthodontics. As I have mentioned before, I use her for my own kids, and I also recommend her to the families I work with. 

Melissa: What if a child cries and fights teeth brushing? Do you having any tips? 

Dr. Green: Some children fight brushing, while others are more compliant. It can vary depending on many factors such as oral sensitivity, gag reflex, and often stubbornness! The best time to get a routine established is in the first year of life. The earlier the better. 

• You can try having the child sit in your lap while you brush, but this makes visualizing the teeth somewhat difficult.  
• Another method is to have the child lay on the floor or on the couch/bed while you brush. It makes seeing the teeth much easier!  
• If your child is aggressively fighting you while you are trying to brush, and you don't have another adult to help stabilize the child while you brush, you can use a towel to wrap the child while holding him in your lap.This will prevent his arms from reaching up to grab you. This works really well on younger children.

Melissa: As an occupational therapist, many of the kiddos with Autism that I work with are very orally defensive, and they perceive brushing teeth as very painful. What are your thoughts on the strategies I use to gently get a child more accustomed to more regular oral care? For example:

• Using clear infant toothpaste (rather than fluoride toothpaste; the taste is more gentle)
• Not using toothpaste
• Using a toothette sponge rather than a toothbrush
• Using a shortened time (while singing ABC’s x 2) 

Dr. Green: I like the techniques you have suggested. I think working up to optimal oral hygiene gradually is a great thing for those that need more time. 

Melissa: For parents with kids who are orally defensive, how important is diet?
Dr. Green: A low sugar diet, especially things that are very retentive (think really sticky and sugary), is very important. Even gummy vitamins can be really bad on a child's teeth. The bacteria that cause cavities metabolize/eat sugars. So, if your child's diet is high in sugar, the bacteria are being fed often, producing more acid, which leads to cavities. The more orally defensive a the child is, the more attention needs to be placed on diet.  

Melissa: What are your feelings about drinking juice, soda, etc?
Dr. Green: Many parents don't realize how bad soft drinks are for their child's teeth. They are very acidic and often loaded with sugar, which can be very damaging to the teeth. A child should be drinking mainly water and unsweetened milk at meal times. 

Melissa: Any other tips for good oral care at home?
Dr. Green: Unfortunately, sometimes kids get cavities, and we have options based on the child's level of comfort and treatment needs. We try to make it as comfortable for both child and parent as possible, but prevention is always better! Plaque (a sticky film on the teeth where bacteria grow) forms on the teeth after eating or drinking. Brushing and flossing removes plaque. Establishing a good oral health care routine at home, where parents are actively involved, is critically important.  

A special thanks to Dr. Karen Green for participating in this month's Blogs!

front office area at Pediatric Dental Associates and Orthodontics

 Have you had particular difficulties or successes caring for your child's baby teeth?
Please share! share@childrenstherapyteam.com

References:

Pediatric Dental Associates & Orthodontics, Fayetteville, AR
Visiting the Dentist for kids with Sensory Defensiveness, Children's Therapy TEAM Dear Melissa Blog for Parents (February, 2015)
Baby Teeth...Big Concern, Children's Therapy TEAM Dear Melissa Blog for Parents (February, 2015)

American Academy of Pediatric Dentistry

American Academy of Pediatric Dentistry for Parents 

Baby Teeth...Big Concern!

credit: Envato Images

Dear Melissa,

I have a 4-year-old son with a diagnosis of Autism. He has extreme defensiveness to touch, food textures, and he gags easily. This oral sensitivity also makes brushing teeth a nightmare! He refuses to let me brush his teeth and refuses to brush them himself. I'm hoping that not brushing or flossing will be OK because he just has baby teeth. 

I'm sorry to hear about your struggles! Learning tooth brushing skills is tricky for many kids, and for children with Autism the challenge can seem insurmountable. I will respond to your question fully over my next few posts.This week I will tackle your comment about brushing and flossing baby teeth.

We can certainly "hope" that not brushing or flossing will not cause any long term problems for our kids, but is this really the case? I respect the opinion of Dr. Karen Green, a local Board Certified Pediatric Dentist from Pediatric Dental Associates & Orthodontics. I'm again reaching out to her to respond to your comment.

Melissa: What is your response to the idea that not brushing baby teeth is OK because they are not permanent teeth?
Dr. Green: Even if your child does not like brushing, it is very important to brush the baby teeth. There will be some baby teeth in your child's mouth until around age 12. Not brushing can lead to cavities. Cavities are a bacterial infection in the mouth, which can cause severe pain and swelling if not treated. If a tooth gets infected, it may need to be taken out early. A baby tooth that is taken out early may lead to increased crowding with the permanent teeth.

painful, decayed baby teeth
image credit: Envato

Melissa: OK, so care for baby teeth is very important!
Dr. Green: Yes, and baby teeth are very susceptible to cavities, as the enamel (outer and strongest layer) of the tooth is much thinner than in an adult tooth. Good oral hygiene and a healthy low sugar diet are the best way to prevent cavities from forming! Children that have cavities in their baby teeth are also more likely to have cavities in their adult teeth. Protect those teeth from the start!

A special thanks to Dr. Karen Green for participating in this week’s blog!

front office area at Pediatric Dental Associates and Orthodontics

 Have you had particular difficulties or successes caring for your child's baby teeth?
Please share! share@childrenstherapyteam.com

References:

Pediatric Dental Associates & Orthodontics, Fayetteville, AR
Visiting the Dentist, Children's Therapy TEAM Dear Melissa Blog for Parents (February, 2015)

American Academy of Pediatric Dentistry

American Academy of Pediatric Dentistry for Parents 

Dentist Visits for Kids with Sensory Defensiveness

image credit: envato

Dear Melissa,

I am worried about my son's first dentist appointment. It is scheduled next month! My son is 5 years old and has a diagnosis of Autism. He barely lets me brush his teeth due to his sensory defensiveness.

In my work as a pediatric occupational therapist, I help prepare my kiddos for the dentist by practicing ahead of time. I have them lie down on their backs while I gently “tap” their teeth. We gradually work towards me brushing their teeth with a regular then electric toothbrush. We also read and write stories about going to the dentist. However, as a mom and sensory-based occupational therapist, I know that the particular dentist and hygienist you choose really matters.

It is very common for children on the Autism Spectrum and children with Sensory Processing Disorder (SPD) to have various forms of oral defensiveness. Therefore, it should not surprise us that these children are often terrified of the dentist. When it comes to finding the right dentist, I use Dr. Karen Green for my own kids, and I also recommend her to the families I work with. She is a Board Certified Pediatric Dentist at Pediatric Dental Associates and Orthodontics. I have found the staff to be very calm and patient. I recently reached out to Dr. Green to gain her perspective on this subject. 

Melissa: What do you wish a parent would tell you (the dentist) before their child’s first dental visit if the parent thinks that the child will have a stressful time?
Dr. Green: If you are concerned that your child may have a stressful first visit, let us know. It is nice when the parent informs us as to how oral hygiene procedures usually go at home. Is the child is resistant to brushing? Do they scream at the sight of floss?

Melissa: What do you wish a parent would tell/do with their child before their first dental visit to make it less scary?
Dr. Green: It may be helpful to bring your child to the office for a "comfort visit" where you show the child the office and let them become comfortable in the environment. Books, pictures and/or videos about going to the dentist are often helpful. It also may be beneficial to practice brushing your child's teeth while they are laying down. Know that if you as the parent are overly anxious about the dental visit, the child will usually pick up on this anxiety and become more nervous.

Melissa: What can the dentist/dental office do to help alleviate fears of the child/parent?
Dr. Green: The dental home you choose for your child should be willing to help lessen the fears by providing an inviting atmosphere and using kid-friendly phrases for dental tools and procedures. We use phrases such as “train whistle” instead of drill,"silly nose" instead of gas mask, and "brave air" instead of nitrous oxide. We avoid the use of the word “shot”, we often describe it as “giving your tooth a little sleepy juice”.

Melissa: At what age should a child first see the dentist?
Dr. Green:The first dental visit should be scheduled after the eruption of the first tooth and no later than 12 months of age (as recommended by the American Academy of Pediatric Dentistry). Prevention is key. Dental problems often start early, and the sooner we catch a problem or potential problem the better! We address diet, hygiene, age-appropriate injury prevention, and counseling for nonnutritive oral habits (e.g., finger sucking, pacifier, blankets). We also provide anticipatory guidance (what to expect for your child's developing mouth).

Melissa: How often should most children see the dentist?

Dr. Green: For most children, we recommend seeing the dentist every 6 months. This is adjusted based on the needs of the child.

A special thanks to Dr. Karen Green for participating in this week’s blog!

front office area at Pediatric Dental Associates and Orthodontics

So here's the bottom line. If you think your child may have trouble visiting the dentist, COMMUNICATE! Talk to the dentist, talk to the dental hygienist, and talk to your child’s occupational therapist and speech therapist. They are all fabulous resources to help keep your little one happy and smiling!

What tricks have you used with your kiddos to help make dental 

appointments less stressful?  Please share! share@childrenstherapyteam.com

Pediatric Dental Associates & Orthodontics

American Academy of Pediatric Dentistry

American Academy of Pediatric Dentistry for Parents 

ADHD Treatment: Where do you start?

credit: envato

Dear Melissa,

My daughter’s kindergarten teacher is concerned that she has ADHD. How do I know if she has ADHD or not? If she does have ADHD, what are the best treatment options?

Last week I tackled the first part of your question in my blog post, "ADHD or just being an active kid?" This week I'm addressing the second part of your question. 

How is ADHD treated?

According to the CDC, in most cases ADHD is best treated with a multifaceted approach. This can include medication, behavior therapy, parent training, and school accommodations. Because roughly 10% of American children have a diagnosis of ADHD, there have been many, many, MANY books written about additional treatment options. Some of these options are sound and have research to support them; others are no better than snake oil. Unfortunately, inappropriate treatments can actually cause harm. It is very important to discuss all of your child’s ADHD interventions, both pharmaceutical and non-pharmaceutical, with your child’s pediatrician or mental health professional.

Behavioral Interventions

With so many treatment options, where do you start? According to the American Academy of Pediatrics, treatment for preschool-aged children should start with evidence-based behavior interventions BEFORE any medications are considered. This is where many pediatric Occupational Therapists can help. By working with the child, their families and teachers, strategies are used to:

• address impulsivity 
• regulate emotional outbursts 
• improve focus and attention

Also in my role as an OT, I help children with ADHD “catch up” on any splinter skills such as handwriting, making friends, and self-care. These are not developed properly due to difficulties attending to tasks.

Medication

Several different types of medications may be used to treat ADHD. Children can sometimes react differently to various ADHD medications. Because “trial and error” may be needed before the right combination is found, parents must work closely with the child’s prescribing physician. Any side effects need to be reported; you should not just stop a medication on your own.

Though it may seem counter-intuitive, stimulant drugs work well for many children with ADHD. Think of it this way. When the drug provides a child brain with sufficient stimulation, then the child is less likely to constantly seek out additional stimulation from his or her environment. Between 70-80% of children with ADHD respond positively to stimulant medications. 

Currently, stimulants are the best-known and most widely-used treatments. A recent study published by the American Academy of Pediatrics found that treating ADHD with stimulants is NOT associated with reduced growth patterns in children as they reach adulthood. However, decreased appetite and difficulty sleeping have been observed as possible side-effects. Non-stimulant drugs were approved for treating ADHD in 2003 and appear to have fewer side effects.

Importance of Treatment

Regardless of the treatment approaches you choose, the bottom line is simple: get your child’s symptoms under control. Children with unmanaged ADHD are at a higher risk for substance abuse, smoking, job loss, divorce, and driving accidents. Therefore, it is imperative to work with your child’s treatment team in order to find what works for YOUR child. 

What techniques have worked for you? Please share!

Please share! share@childrenstherapyteam.com

Resources:

What is ADHD, National Institutes of Health
ADHD or Not? Why a Diagnosis Matters, Web MD, Eric Metcalf (2012)

ADHD, Center for Disease Control & Prevention

ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/ HyperactivityDisorder in Children and Adolescents, American Academy of Pediatrics, Pediatrics Volume 128, Number 5 (November 2011)

Diagnosing ADHD in Children: Guidelines & Information for Parents, American Academy of Pediatrics, (updated January 2015) 
ADHD, Stimulant Treatment, and Growth: A Longitudinal Study, E. Hardstand, Weaver, Katusic, Colligan, Kumar, Chan, Voigt, Barbaresi, American Academy of Pediatrics, Pediatrics, Volume 134, (October 2014) 
Stimulant Treatment of ADHD and Cigarette Smoking: A Meta-Analysis, E. Schoenfelder, Faraone, Kollins, American Academy of Pediatrics, Pediatrics Volume 133, Number 6 (June, 2014)

ADHD Resource Center, American Academy of Child & Adolescent Psychiatry (updated October, 2014)