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Constructing Successful in-Home Oral Care Habits in Latino Children with and without Autism
Dental care is the most prevalent unmet health need in US children (Stella et al., 2002). Children who are from an underrepresented, underserved minority population, like Latinos, or have a special health care need such as Autism (ASD), are at increased risk for experiencing oral health disparities (Fisher-Owens et al., 2013). When intersected, Latino children with ASD face unique and unresearched oral care challenges. Performing routine dental activities can be especially difficult for a child with ASD due to their unique set of sensory sensitivities (Stein et al., 2012). Most literature discussing oral health disparities recognizes a need for further research to mitigate the inequalities, but little focuses on promoting successful home-based oral care strategies like tooth brushing and flossing.
Objectives:
The purpose of this qualitative study is to use videos recorded by parents to explore and compare how 18 Latino children with and without Autism perform in-home oral care routines, note both successful aspects of their routines and areas for improvement, and summarize findings into suggestions for practitioners working with these families.
Methods:
This study employed a qualitative approach to analyzing oral care videos. Eighteen Latino families (8 families with a typically developing child ages 6-12 and 10 families with a child with ASD ages 6-12) were interviewed to identify the factors that impact their in-home oral care routines, including how the presence of ASD may alter their child’s habits. Each family was asked to film their child performing their typical oral care routine for 3 days. A research assistant blindly coded 61 videos (n=30 from a child with ASD and n=31 from a typically developing child) using a checklist of dental behaviors (amount of toothpaste, duration of brushing, etc.), in addition to making notes about unique aspects of the oral care routines. Videos were discussed and co-coded by the research team to decide on final themes.
Results:
From the videos, three themes pertaining to successful oral care practices were observed. The first, Parent Involvement, identifies parents as partners in the oral care process, helping facilitate the activity physically or with verbal cues. The next, Wait, there’s more, describes that tooth brushing was often the only routine performed by the child; noticeably absent were flossing and mouthwash habits, which were often described by parents as too difficult to incorporate into their child’s routine. Finally, Sensory modifications describes being aware of the sensory needs of the child, and modifying the activity to meet those needs, including altering the environment where the activity takes place, or using timers to help establish routines.
Conclusions:
Understanding in-home oral care routines may address oral care disparities in Latino children. This involves addressing the occupation of oral care itself, while also considering the influence of the cultural contexts, family and child descriptors, performance patterns, and systemic restrictions on the activity. By synthesizing components of oral care routines into suggestions for successful practice, we hope to begin the discussion on effective oral care for Latino children.