Tooth decay has increased among U.S. preschoolers, leaving them far more likely to develop oral health problems as adults. The most effective thing that parents can do to prevent tooth decay is simple: brush their child’s teeth twice a day. However, efforts to promote twice-daily toothbrushing through parent and child education have been met with little success. The barrier that parents report most often is child non-compliance or refusal. Dr. Brent Collett is pursuing a new tactic, focusing on parents’ use of behavior management skills.
“When you think about it from the child’s perspective, toothbrushing is pretty intrusive,” Collett says. “It is not surprising that child refusal is common. Many parents get worn down by their child’s tantrums, and begin to question whether it’s worth the battle. Our goal is to identify effective and practical strategies that parents can use to overcome these behavior problems.”
As a first step toward this goal, Collett and Dr. Matt Speltz are conducting an observational study to characterize child and parent behaviors during toothbrushing. For their study, they set up an observation room at the Center for Pediatric Dentistry. Parents who volunteered to participate in the study were first asked to read or play with their child. Then, when prompted by a researcher, they transitioned to brushing their child’s teeth as they would at home.
“We tried to mimic a typical toothbrushing routine, which usually involves transitioning away from something that the child would much rather be doing,” Collett says. Even though parent and child behaviors were likely somewhat constrained, given that they knew that they were being observed, the variety in child and parent behaviors has been notable. For example, some parents have very clever strategies to engage their child by taking turns or using distraction (e.g., singing a toothbrushing song), which minimize child behavior problems before they start. When faced with child refusal, some parents react to their child’s tantrum with gentle persistence while others seem to give up quickly.
“We’re definitely seeing that there are many ways for parents to be successful, or unsuccessful, in accomplishing this task,” Collett says.
Collett and Speltz’s team is now developing a coding system to categorize parent and child behaviors from these observations. This coding system will serve as a measure of oral health behavior, and as a way to identify promising “targets” for behavioral intervention. In collaboration with researchers at the University of Washington, they are also developing an intervention that would provide parents with “coaching” in the use of effective behavior management skills.
The next step will be to test this intervention on a large number of families to determine whether it has a meaningful effect on behavior and oral health. Collett hopes to eventually be able to offer evidence-based techniques that are proven to help parents break through behavior problems and succeed in brushing their kids’ teeth.
“If we can prevent tooth decay among preschoolers, we believe that we can have a pretty dramatic impact on their future health,” Collett says.
For Collett, a psychologist who sees patients at Seattle Children’s Early Childhood Clinic, the research fits into his larger goal of helping parents improve their kids’ behavior in ways that benefit their health. But he doesn’t pretend that it’s easy – Collett has two young children of his own, and plenty of first-hand experience trying to persuade reluctant toddlers to brush their teeth.