Hi Jan,

My son, Adam, will be 3 in a couple of months. I work outside the home as a teacher, but I am still nursing him, he sleeps with my husband and me, we try to be gentle with him during tantrum-like behavior, and my mom (a very loving grandma) watches him during the day. He is a wonderful child with a lot of personality. He, of course, will scream when he can't have something or do something he wants. Most of the time he is able to direct his play and activities during the day. I also know that children are ready for various things at different times.

I am a bit worried about him not brushing his teeth since I have noticed a line of what I guess is plaque going across his teeth near his gums. He does put the toothbrush in his mouth and move it around and he sees us brush our teeth. He will not let me brush his teeth for him. I thought I might try to wipe or brush his teeth after he nurses to sleep in my lap sometimes (that is how I get his nose clean!). I wondered if you had any other suggestions for me.

- Wendy

Hi Wendy,

I know first-hand how challenging it can be when a child resists doing something that we want him to do or feel that he needs to do. Even parents who understand the importance of respecting their child's autonomy will sometimes find a real conflict between what they feel the child needs to do and what the child wants to do, especially where there are health or safety factors. Because Adam is not yet verbalizing his feelings clearly, that makes it even harder to analyze the problem and to solve it.

If a child resists tooth-brushing, what is he saying? There are so many possibilities here. He may be saying that he doesn't like the look of the toothbrush, or the flavor of the toothpaste (he may even have a hidden allergy to one of its components). He may have swallowed toothpaste once and is afraid it will happen again. His gums may be hurting because a tooth is coming in (have they all come in yet?) Perhaps tooth-brushing is becoming an issue and he doesn't like the feeling of being "on the spot". He may not understand why brushing is so important (this connection can be difficult to make at such a young age). He may simply not understand how to brush his teeth and feels confused about how to do it.

Before there is clear verbalization, it's all guesswork. Physical forms of communication, such as pointing and facial expressions, can be helpful, but there is a wide range here too as to how demonstrative a child will be when they don't know the words to use. One child will pull a parent to the front door and tug on the doorknob to let us know they want to go outside. Another child will look out the window with his hands in his pockets! Even the most closely-bonded parent can be left to wonder what is being communicated.

So we are left with guesses and possible options to try. As I suggested earlier, you could try a new toothbrush or toothpaste, especially ones that he himself has chosen. To avoid possible allergy-related resistance, you could try a toothpaste that has no food color, sugar, or chemicals. One we like is called Dabur. Or try the new Soladey2 toothbrush from Japan (carried at some health food stores) that we have also used – it doesn't require toothpaste and is marketed as "the most efficient plaque reducing toothbrush".

Adding fun to a job always makes it easier for a child. Have you tried a dentist kit? He could be the dentist with you as the patient, and then you might be able to switch roles and brush his teeth. It really is better in some ways for the parent to do the brushing for a young child, because it will be more thorough, and therefore can be done less often.

Some families make the job more fun by using an egg timer – they and their child brush until the sand runs out. I've read of one family who played "decay detective" by bringing several kinds of food into the bathroom and eating one at a time, then inspecting their teeth in the mirror. They would then brush and re-inspect their teeth. When a child more clearly understands the reason for brushing, it is usually easier to motivate them.

Some families find a friendly dentist willing to have the child visit with no dental work, and no pressure on the child, just a demonstration of brushing that he can watch. Finding such a dentist now, and introducing him/her to Adam could be a big help later in case any urgent work is needed. But be very careful here. Do a lot of research first (La Leche League leaders may be one good resource), visit the dentist by yourself before bringing your child, and if you arrange a visit, make it absolutely clear that you will be present at all times and that no work is to be done on this visit even if the dentist happens to notice something. That way you can make Adam the promise that the dentist will not be doing any work, and keep that promise.

Here are a few suggestions:

1. Brushing Well by Helen Frost
2. Show Me Your Smile: A Visit to the Dentist by Christine Ricci
3. Dental tools (like the little mirror used for examining teeth) can help a child to become comfortable with some of the items he'll see at the dentist's office. Look for real ones, not toys. Real tools are always more highly prized and used than toy ones.

I hope this is helpful. Let me know if you have any more questions.

Jan