Head Start

Are there ways to position children with special health care needs to make it easier for a parent or caregiver to effectively brush the child's teeth?

There are many ways to position a child with special health care needs for toothbrushing. These may change with a child's age, and they depend on the child's condition.

No matter what method is used to position a child, it is important to remember to support the child's head, making sure you can see inside the mouth and that you can move the toothbrush easily in the mouth. To prevent choking or gagging, do not tilt the child's head back. Also, make sure that you do not trigger other types of reflexes. This is particularly important in children with cerebral palsy. Work with the child's oral health professional to find the safest and most comfortable position for you and the child.

Two often-used methods can be used for children in wheelchairs:

• Stand behind the wheelchair. Use your arm to brace the child's head against the wheelchair or against your body. A pillow can also be used to make the child more comfortable.

• Sit behind the wheelchair and tilt it back into your lap. Remember to lock the wheels of the wheelchair.

For children who are not in wheelchairs, a variety of positions can be used:

• Sitting on the floor—Have the child sit on the floor, and sit right behind the child, on a chair. Lean the child's head against your knees. If the child is uncooperative, you can gently place your legs over his or her arms to keep them still.

• On a sofa or bed-—Place the child on a sofa or bed lying down, with his or her head in your lap. Support the child's head and shoulders with your arm. If the child is uncooperative, a second person can gently hold the child's hands and feet.

• In a beanbag chair—If it is hard for the child to sit up straight, sitting in a beanbag chair may allow the child to relax without fear of falling. Use the same position as described previously for toothbrushing on a sofa or bed.

• Lying on the floor—Place the child on the floor lying down, with his or her head on a pillow. Kneel behind the child's head, using your arm to help hold the child still, if necessary.

• Lap-to-lap examination—Position the child's head in your lap, while another parent or caregiver sits in a chair, gently holding the child's legs in his or her lap.

Performance Standards

1304.21(a)(5)(ii)

1304.21(a)(5)(iii)

1304.23(b)(3)

References

Domoto PK, Oberg D. 1998. Lap-to-lap examination procedure. Seattle, WA: WSDA News.

National Maternal and Child Oral Health Resource Center. 2005. Oral Health for Children and Adolescents with Special Health Care Needs: Challenges and Opportunities. Washington, DC: National Maternal and Child Oral Health Resource Center.

Perlman SP, Friedman C, Fenton SJ. 2008. A Caregivers Guide to Good Oral Health for Persons with Special Needs. Washington, DC: Special Olympics, Healthy Athletes, Special Smiles.


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