Oral Care with Feeding Tubes

Oral care with a feeding tube can present it’s own challenges, but it is very important for overall health.  Just because a child doesn’t eat by mouth, doesn’t mean that we can skip care for their teeth. Teeth are actually very important!  Feeding tubes are not always permanent in children, so we need to make sure their teeth are ready for when they are able to start taking food or drink by mouth!

Why is oral care so important for babies?

Oral care is truly important for everyone, but it is especially important for babies.  Decayed baby teeth can cause a variety of long term issues like:

• interfere with speech development
• if decay leads to premature fall out, the baby teeth won’t hold the spot for permanent teeth and this will cause crooked teeth.
• periodontal disease (starts with gingivitis which is bleeding and inflamed gums and eventually becomes periodontitis which is when gums pull away from teeth leading to bone loss and teeth loosening/falling out.)
• periodontal disease has also been shown as having a link to eventually having diabetes
• heart disease (the bacteria in your mouth can enter your blood stream which can lead to heart disease and stroke. 

It’s best to get into a routine early before teeth even start to form, and this is also a way to help avoid oral aversion!  It is believed that children with a feeding tube can have thicker secretions in their mouth and this can lead to more plaque build up.  Normally when someone eats and chews with their teeth, this can cause food to scrape some of this plaque away, but if a child is not able to eat by mouth, this plaque just builds and builds until it causes cavities.

Can acid reflux harm your teeth?

It is very common for a child with a feeding tube to also have acid reflux.  Acid reflux is basically acid that travels from the stomach up to the esophagus.  Another symptom is regurgitation of a sour or bitter tasting acid that backs up in the throat or mouth.  

Stomach acid can destroy the enamel (outer layer on teeth) and the dentin (just below the enamel layer on teeth.  As the enamel layer is damaged this can lead to pain, sensitivity, discoloration of teeth, and a higher risk of cavities/tooth loss.

13 tips to help make oral care easier for children with feeding tubes!

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1. Disposable Oral Swabs– these can be found inexpensively on Amazon ,   they are basically little sponges on a stick that can be used with infant toothpaste, dipped in mouth wash, or just plain water.
2. Z-Vibe sensory vibrating brush– can be found on Amazon and is usually part of a kit with different tips.  These kits work very well for oral stimulation and to overcome oral aversion.  Make sure to get one with a tooth brush tip! https://ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ss&ref=as_ss_li_til&ad_type=product_link&tracking_id=upcyclequilta-20&language=en_US&marketplace=amazon&region=US&placement=B001BC2C9S&asins=B001BC2C9S&linkId=faea4f957e4205e581783f3955fb1d86&show_border=true&link_opens_in_new_window=true
3. Kid’s Vibrating Toothbrush–  the Z-vibe can be a little pricey, so a great alternative is to get a simple vibrating toothbrush made specifically for kids aged 0-3 years old.  Most come with multiple replacement heads.
4. 3 Sided Brush– these are basically a toothbrush with bristles on three sides of the head so you can get in and get out super quick.  This works really well if your child will only let you brush for a couple of seconds.
5. Cotton Q-tips dipped in a mixture of 50% water and 50% kid friendly mouth wash.  This trick works really well if your child won’t open their mouth very wide for you.
6. Baby Wash Cloth–   most of us have a ton of these on hand, and all you need is a drop of toothpaste and gently scrub the teeth and gums with your finger covered by the wash cloth.  This gives good oral stimulation as well.
7. Jack & Jill Toothpaste– this is an all natural, vegan, and gluten free toothpaste for kids. I really only like it because it comes in yummy flavors like strawberry and blueberry, so if your child hates other toothpaste flavors, it might be worth the extra money to try this.  This toothpaste is safe to swallow.
8. Baby Toothbrush and Baby toothpaste– it seems so simple, but it works.  We found using the basics to be really easy if your child has a sibling.  We brush our 4 year old’s teeth, and then our 2 year old’s teeth.  It is totally a monkey-see monkey-do thing.  If you don’t have a sibling to mimic, have your child watch you brush your teeth, and then make it their turn.  Check out your local dollar store, I occasionally score sets of baby toothbrushes and toothpaste for $1.00!
9. Kid’s Safe to Swallow Mouthwash– they make a specific alcohol free and safe to swallow mouthwash just for children.  You can dip an oral swab or toothbrush in it and then brush the teeth with it.  The flavor is usually bubble gum!
10. Gauze Cloth Finger Toothbrushes– this is basically a small piece of gauze that fits on your finger and is super soft.  This works really well for those with extreme sensitivity on their gums.
11. Lemon Glycerin Swabsticks– these are kind of a mix between a Q-tip and a sponge swab.  They are actually made for those that have dry mouth.  They do actually taste citrusy too!
12. Silicone Finger Toothbrushes–  These are a flexible tube that fits on your finger and it has bristles built in.  If you have a child that loves to suck on fingers these will work great!  Once your child has teeth, beware that it does hurt if they bite down on this brush on your fingertip! (OUCHIE)
13. Banana Baby Brush- shortly after getting the hang of teeth brushing, my daughter demanded to hold it by herself.  A lot of the other options were a little too difficult for her to maneuver by herself, so this brush in the shape of a banana is a great way to include your child in the brushing routine!

As with any routine, it really takes a lot of consistency and practice to make this work.  A lot of children with feeding tubes have oral aversion that can range from slight to severe, so we need to find out which way your child will respond best.  I would personally attempt all of the easiest options first, and see how your child reacts.  This should also give you some clues if they seem to not like bristles or if they do not like certain tastes.

Don’t give up too soon on Oral Care!

Just because a child refuses one way today, they may tolerate it in a week or two.  If they scream and cry with a method, simply try again the next day.  If after a few attempts, they are still screaming and crying, it is time to try another method.  Save the failed method to try in a few weeks.

Unfortunately there is no one size fits all to oral care for kids with feeding tubes.  The one super important thing, is that doing oral care now can prevent a lot of pain and sensitivity, plus avoid future dental procedures.  If they don’t like oral care now, they will really hate it after having to go for procedures by a dentist.

We have found the best method for overcoming fear with my children is to talk to them.  We explain at a very basic level what we are going to do.  So we will tell my daughter, that we are going to open her mouth, and let the toothbrush go in.  We are going to “wash” her teeth and sing a little song.  We go to the left side, and then we go to the right.  Now we stick out our tongue and we scrub scrub scrub!  

We always make lots of happy faces and do big high fives afterwards.  Then I thank her for letting me brush her teeth.  I’m not sure why this helps so much, but my children have started to feel joy with you tell them thank you. I think it is because they are understanding that they are “helping you” so they are doing a good thing.

Always try to avoid holding a child down to brush their teeth.  It only takes a few rough times, for them to develop a true fear of having anything in their mouth.  Some days you may only get the toothbrush in the mouth, but not be able to do any scrubbing, and that is ok!  The next day we say “Since you let me put the brush in yesterday, how about we try out just scrubbing on one side?”

Telling a child what comes next, prepares them for what it will feel like.  I also try to explain that this will not hurt and they can tell me to stop.  We want to assure them that this will not be painful and also that we as an adult will listen if they get uncomfortable.

Honestly it is better to get some partial teeth brushing in then to get none at all, so I like to celebrate the tiny victories and continue to work on the long term goal.  You can also start a reward chart with stickers as a way to show your toddler how well they are doing!