In-Home Oral Care Habits in Latino Children with Autism: An in-Depth Look

Background:

Dental care is the most prevalent unmet health need in US children. Children from underrepresented and underserved groups (i.e., Latinos, those with Autism (ASD)) are at increased risk for experiencing oral health disparities. When intersected, Latino children with ASD face unique, unresearched oral care challenges. Literature discussing these disparities recognizes a need for further research, but little centers on promoting successful home-based oral care strategies, nor focuses on other factors (i.e., diet, culture, systemic barriers) that may impede oral health.

Objectives:

The purpose of this study was to explore the factors that affect oral care routines and impede overall oral health in Latino children with ASD using data collected via videos, visual food journals, and narrative interviews.

Methods:

This study employed a qualitative approach. Ten Latino families with a child with ASD aged 6-12 were interviewed to identify the factors that impact their oral health, including how the presence of ASD may alter their child’s habits. Each parent/caregiver completed two interviews, and each child completed one interview (n=30 interviews). All interviews were audio recorded and transcribed verbatim, and thematically analyzed by the researchers. Additionally, each family video recorded their child performing typical oral care routines for 3 days. Two research assistants blindly coded 37 videos using a checklist of dental behaviors, noting unique aspects of the routines. Lastly, families submitted photos of their child’s meals as part of a visual food journal (n=95 photos). One research assistant documented content of photos and noted overlapping food patterns.

Results:

The interviews yielded three themes related to factors impacting overall oral care and routines. “Estoy sóla” described how parents of children with ASD felt isolated. From finding an appropriate dental provider to getting their child to complete oral care activities, parents felt like they were the only ones who could ultimately help their child. “Wait, there’s more” portrayed tooth-brushing as the only routine often performed by the child; parents labeled activities such as flossing and mouthwash as too difficult to incorporate. “It’s a Battle” described how parents had a precarious relationship with their child’s oral care habits, and forcing self-care activities led to disagreements. From the videos, two themes pertaining to oral care practices were observed. Parent Involvement identifies parents as partners in the oral care process, helping facilitate the activity physically or with verbal cues. Sensory modifications describes being aware of the sensory needs of the child, and modifying the activity to meet those needs, including altering the activity environment. Lastly, from the photos, the lack of water consumption was noteworthy, as none of the families submitted any pictures where their child drank water. Instead, children drank more cariogenic beverages (i.e., soda, juice).

Conclusions:

Together, these data provide rich content regarding the factors impacting oral care routines and overall oral health in Latino children with ASD. This research is novel in addressing the occupation of oral care itself, while also considering the influence of cultural contexts, diet, family and child descriptors, performance patterns, and systemic restrictions on the activity.