[crazycat]

Hi there,

My 4-yo has a lot of sensory issues (spent 20 months in the hospital when he was born, and even today his "teadybear" is an old trach mask and fuzzy animals just get thrown as quickly as possible) and he has a *very* strong oral aversion (still tube fed entirely because of this). Needless to say, toothbrushing is a big struggle. The only way I can even get into his mouth is with an infant finger brush, and then it's by holding both his hands together with one hand and holding his head under my armpit while he squirms and twists to get away. I don't feel real great about this approach, but he HAS to have his teeth brushed because he gets a steroid inhaler twice a day that will cause thrush if we don't clean his mouth out afterwards. Since he doesn't know how to "swish and spit" we have to brush his teeth and give him a sip of water, and tiny sips are all he will ever take so the toothbrushing is really the only thing cleaning his mouth anyway. So, we have tried vibrating toothbrushes - he is terrified of them. We have tried regular toothbrushes and he hates those and fights them harder than the finger brush, and I am always afraid we will hurt his gums since they are so hard if we slip at all with his fighting. The thing that gets me most is he seems to have turned it into a game, as he is LAUGHING the whole time he is trying to twist away, until I actually get my finger in his mouth, and then he starts gagging and crying. I expected that he would get better with time, but he really hasn't. Any ideas or experiences?

 

[USAmma]

My 4yo suddenly started to love teeth-brushing when I let her pick out her own character electric toothbrush *and* her own kid toothpaste. I try to let my kids have as much control as possible with the little things-- I showed Abi how to put the paste on her brush and how to rinse it off afterwards. I have never compromised on whether or not the teeth are brushed, though. At times dh and I have just held them down to do it. It's not fun, but it's a lot better than being strapped into a papoose in the denist's office for dental work.

 

[crazycat]

Thanks for the reply! I agree with the toothbrushing not being an option, I am just wishing we could find a way to make it easier on everyone, especially DS. I have tried giving him choices between toothbrushes, but whenever he sees one he freaks out and won't pick anything, just try to throw them as far away as he can get them and cry. I will try the toothpaste options. I'm really not sure what he understands verbally, though, so while I do explain everything to him in case he understands it's hard to know if it's really helping. Sometimes he seems to understand things, like if I say "wait for mommy please" when we go out the front door he will wait at the top of the steps, but when I talk to him about other activities (like going outside, which he loves to do) he doesn't seem to understand unless I go stand by the door or have whatever it is that I'm talking about in my hands. Plus his vision is very poor - only peripheral vision and is extremely nearsighted (legally blind) with what little vision he does have, so that doesn't help him either, with toothbrushing or anything else. However, he definitely recognizes undesirable objects so he must see enough for that I guess. Thanks again!

 

[thoesly]

We had major toothbrushing struggles with my oldest. One thing that helped make it a little less awful was to sing. I made up a special toothbrushing song that distracted him initially because it was so silly. By the time the novelty wore off, he at least understood that toothbrushing would be over when the song was over -- kind of like an "audible timer" telling him exactly when the torture would end. It was still hard, but at least it became bearable.

 

[PikkuMyy]

You might want to try a picture task analysis with him - where you have a series of pictures showing the steps of tooth brushing so that he can see what's involved and how close he is to being done. He can also feel more in control because he knows what will happen. You can print them in very simple black and white very large or make them 3D - which is done for blind children with developmental or cognitive disabilities. Each step is a card with something glued onto it that represents the next step or object.

If he only understands receptive language in context, then he probably doesn't actually understand it. He just knows that when he hears those sounds at the front door, he needs to stop.

Are you seeing an oral or speech therapist? There are many "tools" out there to help with oral aversion therapy

beyondplay.com
superduperinc.com

like different types of brushes and vibrating teethers, etc. that will help your son learn more about his mouth and oral control and getting used to different sensations.

You also might want to take some time off of the "full mouth brushing" for even a few days to find ways of doing just part of his teeth that lets him be more comfortable and have the time be shorter so that he has a more positive experience with it. For example, perhaps using a very soft finer brush on just the front of his front teeth (he doesn't even have to open his mouth) would enable it to happen quickly and much more comfortably for him. Then you slowly add more to the steps until you are doing his whole mouth.

Are you using positive reinforcement after brushing teeth? Is he able to make choices? If he is, I would always give him a choice of what he wants to do after you finish brushing his teeth. That way he can look forward to whatever it is and know that he will get rewarded for letting you brush them.

If he can't make choices, then I'd say that is a much more important issue than the tooth-brushing itself and you really need to find ways that he can.

I would also explore teaching him how to use the brush himself so that he can feel more in control. You will probably need to look at catalogues like those I posted links to to see what might help him do it better.

Do you have an Early Interventionist or team working with you? They would be able to introduce you to the idea of PECS (picture exchange communication system) that could be made 3D.

 

[Pookietooth]

Have you tried giving him a choice of who brushes his teeth -- when possible? We found that if we ask him if he wants mommy to do it or daddy, he chooses dad, and usually doesn't fight nearly as much. Also, we let him choose where in our home he gets his teeth brushed -- living room, whatever -- and whether he stands or sits. I usually end up holding him sitting in my lap while dh brushes. That, and letting him hold the toothbrush while we do it, or letting him brush his teeth himself first.

 

[sammysmammy]

we've adopted two guys with Down Syndrome.We brought S. home @3 months,tooth brushing just always happened and he's never fought.We brought Manny home right after his 3rd b'day,he was entirely tube fed for chronic aspiration,hadn't had oral stim thru bottle,breast,therapy,anything since he was 10 months.After he about clawed us to death for months when trying to brush his teeth(even after we'de started some oral feeding after a "clean"swallow study)--he still HATED the toothbrush.We finally got a battery operated one,just b/c I felt like we could get the job done faster--I hold him cradled in my arms with my leg hoisted over his and my cradling arm holdind down his claw arm,his other arm behind my back.I know it sounds barbaric,esp.for AP folks

but you do what you gotta do!He goes to the dentist in a couple weeks,I can't even imagine what that will entail!We do have goofy tooth brushing songs we sing,he's usually screaming so loud he can't even hear us!The weird thing is,he loves the actual toothbrush and will push the button to turn it on/off!It's obviously jus the oral issue that freaks him out

 

[crazycat]

Thanks for the responses everyone! I have tried (and keep trying) to give DS choices whenever possible. He really doesn't seem to understand or indicate any preferences, except for pushing away when he doesn't want something (and sometimes crying at the same time). We are working with an OT here at home, and he gets ST, OT, and PT at preschool. Right now our home OT is having us use the electric toothbrush to just brush his arms before we brush his teeth with the infant finger brush. We don't turn the electric toothbrush on, as this seems to just scare him more. The infant finger brush is the only one I have ever been able to actually get in his mouth - which is important right now becuase of his steroid inhaler to get his mouth clean and avoid thrush. I also have been singing a short song when I do the brushing on his arm and when I brush his teeth so he knows when the song is over the brushing is over. It seems to help with brushing his arm, not sure on the teeth yet, as he is still as resistant as ever to that, but maybe less crying so it might be helping. We often count to three with aversive things for him at the suggestion of our home OT, and on the count of three stop whatever it is, and that seems to help with a lot of things but doesn't give me time to get in his mouth and get his teeth brushed, which is why I am trying the song instead. Thanks again for all the suggestions! It just sometimes seems like we are getting nowhere no matter what we are trying, so it sure helps to have all the ideas we can get. Thanks!

 

[judejude]

Everyone gave good feedback I just wanted to say that my kids teeth are gonna rot out of her head any day now due to little to no toothbrushing. The SID will do that. She's having an MRI under general soon and I'll be trying to get the dentist to come clean her teeth then, since she's never had them cleaned---just examined (and that was hell on earth).

I feel for ya.

 

[dmhoob]

Is he as sensitive to touch on the outside of his mouth? If he's OK with that you could try massage to face and cheeks, moving to lips to get him used to being touched around the mouth. I did this with my son, it took a long time, and he still doesn't love toothbrushing, but at least I don't have to pin him down anymore.