Last month, I posted a Q&A about teeth brushing. The American Academy of Pediatric Dentistry thought my answer was too, uh, namby pampy. So when a similar question came along last week, I asked them to weigh in.

Dear Barbara:

My 5.5-year-old son never co-operates for brushing his teeth. Every
morning is a stress, I tried several methods like reading books on health
care. Though theoretically he is aware of what are germs, still neither he
brushes nor he allows me to do the same. Even to go to toilet he
refuses, though he has the urge to go, but still he avoids to go. Please help
me on these two problems.

From: Tarun, Singapore

Hi Tarun

(Wow, Singapore! That's pretty cool.)

It sounds a bit like your son is being oppositional just because he can and that makes me wonder if you are too controlling. I suggest finding as many ways as possible to give him more control, particularly by giving him choices -- "Do you want to wear the red shirt or the blue one?" "Do you want to brush your teeth before or after your bath?" That way, you're not only making it clear that you respect his opinion and decision and that he has control over the logistics but also that the option isn't to not get dressed or to not brush teeth. Read this for other ideas of ways to eliminate power struggles.

Meanwhile, Dr. William C. Berlocher, president of the American Academy of Pediatric Dentistry is very clear that teeth-brushing cannot be a choice. In a nutshell, he says parents must be persistent, patient and pleasant each and every day and not give up on this. Here's the full statement he sent me:

"Children who have discovered they have some control in their lives and are resistive [sic] to their parents direction/instruction can be a more challenging issue. A term that I've found to be extremely useful in these situations is "Cheerful Persistence". First of all, parents need to be positive and keep a smile on their face when working with their child. Parents give many nonverbal cues to their children. If you go into a tooth-brushing session looking like you're going to war, more than likely it will be just that! Secondly, oral hygiene is something that works only if it is undertaken on a regular basis. Therefore, daily brushing is a must. Avoiding tooth brushing because of the potential for a clash between a child and parent dramatically increases the potential for development of dental cavities and makes a bad situation worse. So, persistence is critical and while it may take some time, things usually change for the better."

In fact, the AAPD advises parents to start in infancy to swab a baby's gums (with your clean finger or gauze) in order to get a child used to oral hygiene. That's what's most likely to avoid the issues you're having at age 5.

Here's another tidbit from AAPD: It recommends transitioning from the bottle (or breast) directly to a cup, not to a Sippy Cup, unless you (a) use only water in the Sippy Cup or (b) only use the Sippy Cup at mealtime.

It's not that the Sippy Cup itself is bad, the problem is what goes in it. AAPD Public Affairs Coordinator Marianthi Bumbaris says, "The issue is frequency and duration. A toddler tends to carry the cup around with her, giving her more access to a sugary liquid." That frequency and duration can increase the risk of cavities even though teeth are not in yet, she says.

Here are some other recommendations for preventing cavities in preschoolers.

When it comes to the issue of toileting, I'd try telling him, "You're old enough to be in charge of your own body. I'm going to stop asking you if you need to go because you know when you need to go, not me. If you need my help, just let me know." No self-respecting 5-year-old is interested in having accidents and this kind of response from you is a sign of respectfulness that he will appreciate. Here's the caveat: Don't do this unless you are really ready to relinquish this control.

If he is not able to handle toileting on his own at this age, consult with your pediatrician.

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