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Preschoolers and cavities: another example of the Who's-In-Charge? problem

Posted by Dr. Claire McCarthy  March 18, 2012 10:07 AM

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A couple of weeks ago I read an article in the New York Times about preschoolers and cavities, and I haven't been able to stop thinking about it.

The article described how there has been a marked increase in dental cavities, and in procedures to fix them, in 2- to 5-year-olds.The Centers for Disease Control noted it in a report they published, and the New York Times article quoted dentists who say that they are seeing more cavities than ever before in preschoolers -- so many, sometimes, that they need to put the kids under anesthesia to get them all fixed.

The dentists talked about all sorts of reason for this trend, like using bottled water that doesn't contain fluoride, endless snacking, drinking sugar-containing beverages and not enforcing toothbrushing.

I think it's another example of the Who's-In-Charge? problem.

I can't tell you how many times I hear parents say, "but he doesn't want to," or "she doesn't like it." I hear it when I talk about brushing teeth, so I wasn't surprised by the article. I also hear it when I talk about giving up the bottle. Or switching to water from juice. Or turning off the television. Or having a consistent bedtime. Or eating vegetables. Or reading books instead of playing video games.

Now I've got kids, too. I know that not every kid likes to brush his teeth or turn off the TV or eat broccoli. But what makes me crazy is that with many parents, the "I don't want to," is the end of the discussion. Really? Honestly, who is in charge?

These are not bad parents. Sometimes they are distracted or overwhelmed and need life to go as smoothly as possible so don't want to take on battles with their kids. Sometimes they simply don't want their kids to be unhappy so let them do what they want. I understand how they feel, I really do. But it's not just cavities we are seeing. It's overweight kids, kids with behavioral problems, kids doing poorly in school. Kids were not meant to be in charge. Parents are meant to be in charge.

It's not easy. "He screams if I don't let him carry his juice cup all day," I'm told. Yes, well, I'd scream too if it got me what I wanted -- and I'd stop screaming if it didn't work. It's not easy to be in charge, I'm with you. In my 21 years of parenting, I've been the Bad Guy countless times, and endured plenty of screaming and anger when my five kids didn't get what they wanted. But holding your ground, as hard as it is, ultimately pays off -- in healthier teeth, healthier kids, better behavior, and better grades.

"You are in charge," I tell parents. "You can do it." We talk about starting small, with battles that will cause smaller amounts of screaming, like cutting back on TV instead of shutting it off, or insisting on eating three bites of vegetables. Baby steps are fine as long as they keep heading in the right direction.

That's the message of the rise in cavities in preschoolers: we are headed in the wrong direction. We need to solve the Who's-In-Charge? problem before things get any worse.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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