Most kids run away from the sight of the “terrible toothbrush.” However, for children on the autism spectrum with sensory issues, this can be even more of a challenge. There can be many different factors and reasons for a child’s aversion to toothbrushing. There may be some hypo- or hyper-sensitivity and oral defensiveness going on. With hypo-sensitivity, kids might have less awareness of what’s going on in their mouths, which can contribute to anxiety related to the mouth area (think of it as a type of oral “numbness”). On the flip side, kids who are hyper-sensitive might be overly conscious and sensitive to oral stimulation. The slightest touch can be overwhelming and be perceived as painful.
Although I am a licensed occupational therapist, the tips below are general suggestions and not an individualized therapy plan. If you have concerns, a speech-language pathologist or occupational therapist trained in oral motor therapy can offer a complete an evaluation and put together an individualized therapy plan with recommendations that take all factors into consideration.
However, for some general ideas and helpful insights that can be used in a trial-and-error type of approach, read on! Below you will find my tips that might help your child be more independent with toothbrushing and keep those pearly whites squeaky clean.
1. Some children may find the sensation of the bristles uncomfortable. Try using a brush with extremely soft bristles or silicone bristles. A baby toothbrush could be a useful transition tool to help your kiddo eventually transition to a regular brush. For example, the Banana brush is a baby training toothbrush that has short bristles made of silicone that can help to desensitize.
2. A toothbrush that can get the job done faster. For example, a three-sided toothbrush such as DenTrust cleans faster and gets all three sides with just one brush motion. The bristles are super soft to gently clean the gum tissue.
3. Experiment with different toothpastes. Some kids don’t like the taste of the mint and can perceive it to be a painful, burning sensation. Try different flavors of toothpaste, such as bubblegum, strawberry, orange, etc.
GUM Crayola Squeeze-a-Color comes in toothpastes that are all different colors and flavors (melon blast, blueberry burst, and jazzy apple). You can let your child squeeze a little from each tube to mix and match the colors and flavors and have some fun with it. Also, Banilla Bling is a vanilla ice cream flavored toothpaste.
4. If your child is sensitive, maybe flavored toothpaste isn’t the best option. Also, the foaming of the toothpaste may be the culprit, causing unpleasant sensory sensations and discomfort. Oranurse is a flavorless and non-foaming toothpaste that was initially created for children on the autism spectrum who were were sensitive to strong flavors and taste. Overall, this toothpaste doesn’t foam and has zero flavor, which may help ease your child’s comfort.
5. Focus on finding the right toothbrush. Make sure the toothbrush is the right size for little hands and has soft bristles that don’t hurt gums. An electric Spinbrush can make toothbrushing more fun because some children love the feel of the vibrations. Another fun option is a flashing timer brush (Crayola makes one that lights up for two minutes, letting children know when brushing time is up.)
6. If your child is a music lover, consider a singing toothbrush. There are lots of varieties of musical toothbrushes on the market, from ones that sing songs to ones that make animal noises.
7. If a singing toothbrush with all the fancy bells and whistles doesn’t sound too appealing to you, simply sing a song your child loves while they brush. If the brushing stops, you stop singing. You can even play a favorite song on your phone and pause it if they stop brushing.
8. Brush when your child brushes. Brush your teeth at the same time as your little one. Be enthusiastic about it, making it look appealing.
9. Take turns brushing. Let your little one brush their own teeth first before you do it for them. You can also try and give your child your brush and let them brush your teeth while you brush theirs (it can be a good distraction!).
10. Try brushing teeth while in the bathtub. You can also give your child a cup and some bath toys while you brush his/her teeth at the sink. Water play at the sink is a simple distraction.
11. Brush in front of the mirror. This might help your child feel more control of the situation. Visually being able to see the toothbrushing process can help as opposed to a situation where you’re facing your child and they cannot see what’s going on.
12. Visual supports and schedules. A visual schedule can be created by taking photographs of the steps of toothbrushing. Option 1: You can cut and laminate the photos, putting velcro on the back of each one. Arrange in chronological order on a board and as each step is completed, the corresponding picture is removed. Option 2: Print photos of the toothbrushing process, laminate the pages, and a dry-erase marker can be use to check off each step (so that the page can be reused day after day). Option 3: Snap a picture of each step of the toothbrushing process, load the pictures on to a digital picture frame and program it so that each photo is displayed for 10-second intervals. This can be used in the bathroom as they are brushing their teeth so they have a visual prompt when it is time to move on to the next step.
13. Try a timer. Sand timers or using the stopwatch on your phone are great for making how long to brush more understandable. You can start with just a few seconds and work up to a full two minutes.
14. If brushing really is a battle, it’s completely OK to start small. If your child isn’t comfortable with a regular toothbrush, or the electric toothbrush, start with brushing only one or two teeth for a couple seconds, (maybe with the baby silicone bristle toothbrush?), then stopping. A couple days later, you can “up” the amount of teeth you attempt to brush and add on a few more seconds. It’s OK to try this method and go slow. Sometimes a desensitization process is needed.
15. Consider water temperature. Have you always brushed your teeth with cold water? Is cold water what you use when brushing your child’s teeth? If so, try switching it up and using warm water. You child may be sensitive to the cold water and tolerate a warmer temperature a lot better.
Christina is an OTR/L and owner of Sensory TheraPLAY Box, LLC, the monthly sensory toy box for children with autism and/or sensory needs.
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