Oral health challenges for parents of children with feeding difficulties

Objectives: Describe the challenges to oral health care reported by parents of young children with extreme oral motor dysfunction or chronic medical conditions requiring enteral nutrition or other specialized feeding procedures. Methods: Participants were part of an observational study of the oral health needs of children with special health care needs. The data reported here were obtained by parent interview that asked information about dental care and home hygiene. This study reports on a subset of 30 of the 90 study children, ages 23 through 57 months old, who received ongoing enteral nutrition (“tube” feeding, n=14), and/or feeding therapy, oral aversion or oral desensitization therapy (n=26) due to gastrointestinal tract dysfunction or extreme oral-motor sensitivities. Results: Most (27 of 30) parents reported daily tooth brushing for their children: 14 (47%) brushed on average once per day and 13 (43%) brushed twice or more per day. Approximately half (53%) used fluoridated toothpaste. Twenty-seven (90%) parents said uncooperative behavior of their child was a major challenge to tooth brushing causing some parents to “avoid a fight and not push it” and others to “power through and get it done as best I can.” Eight children (27%) had never been to a dentist. Of those who had, 7 children received one preventive dental visit in the past 12 months, 12 had two visits, and 3 had three visits. Parents commented that seeing a dentist for preventive care is important yet difficult because it is “one more appointment on top of many other appointments.” Conclusion: Previous research has identified a lower caries rate among children receiving enteral nutrition yet significantly higher calculus levels. Strategies to assist parents with home care and assure access to appropriate and regularly-occurring preventive professional treatment are needed to maintain good oral health of these vulnerable children.