Oral Health
Why good oral health is important for babies and children with special education needs and disabilities (SEND)
Maintaining your child’s oral health can help prevent disease, pain, and infections. It also plays a key role in supporting their overall physical and mental health. Good oral hygiene can help your baby or child with:
- Eating,
- Sleeping,
- Talking and communicating.
By looking after oral health, you are ensuring their comfort and well-being in these important areas of life.
Taking care of your teeth can:
- Stop teeth from going bad. Eating lots of sugary snacks or drinks can make teeth rot. If your child needs a special diet, like more calories, be careful with sugar. Try to use medicines without sugar when you can. If you're worried about too much sugar, talk to your child's health visitor, doctor, dentist, or dietician.
- Stop gum problems. Gums can get red, puffy, and sore if plaque builds up. Plaque is a sticky layer of germs that sits on your teeth. To learn more, visit: GOSH: Tooth Plaque.
- Help stop other health problems from getting worse.
- Lower the chance of getting diabetes or lung infections.
- Avoid needing to go to the hospital to have teeth taken out.
- Help your child stay in nursery or school so you don’t have to miss work to take care of them.
Extra care for your child's teeth and mouth
Your child might need extra help with their teeth if they have:
- Crooked or different-shaped teeth– brushing carefully can stop the teeth from getting holes.
- Missing or extra teeth– this might mean they need braces. But some children can’t wear braces, so they might need to have teeth removed instead.
- Dry mouth– some medicines can cause this. Saliva helps stop holes in teeth, so if your child has a dry mouth, give them sips of water. The dentist might also suggest special toothpaste or something to help keep their mouth wet.
- Eating non-food things like dirt or paint (this is called pica) – this can hurt their teeth. Keep non-food items out of reach, and never leave them alone when they play.
- Grinding or clenching teeth– this can wear down their teeth and make them sore. This is common for children who have sensory-seeking behaviours or stimming.
- Injuries to the mouth– some children might hurt their teeth or gums if they have trouble moving, epilepsy, or if they bite their tongue or lips.
- Trouble talking or showing pain– if your child changes how they eat, starts drooling, or has outbursts, it could be tooth pain. If you think this is happening, see a dentist. If it’s not treated, they might need to go to the hospital to have teeth taken out.
Talk to your doctor or dentist if your baby or child has any of these problems or if you are worried. There might be ways to help. Your health visitor, doctor, or dentist can give you advice and support if you need help.
How to keep your baby or child’s teeth and mouth healthy
Brushing your baby’s or child’s teeth helps keep their mouth clean and stops infections. This is really important for babies and children who are tube-fed or have trouble swallowing. You can watch a short video with Dr. Ranj and “Super tooth” to learn about looking after the teeth of children under 3 : Watch the video.
Brush for 2 minutes, twice a day. For children under 3, use a smear of toothpaste, about the size of a grain of rice. For children over 3, use a pea-sized amount. Make sure to brush all parts of the teeth and gums with fluoride toothpaste (1350-1500ppm).
Smear: up to 3 years
Pea-sized blob: 3 to 6 years
Special products can help keep teeth clean. Ask your dentist about these.
Bleeding gums when brushing is normal. Just keep brushing, as it will help clean away germs and make gums healthier.
If your child doesn’t like brushing their teeth, there are some helpful tips you can try.
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When should you worry?
12-18 months
12-18 MONTHS
Contact your health visitor or GP if your baby is 12-18 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag their leg or foot when crawling or walking
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink
- Finds it hard to stand or walk, for example:
- Can’t pull to stand
- Fall over a lot when standing still
- Doesn’t cruise (walk while holding on to furniture)
- Walk on their tiptoes a lot
18-24 months
18-24 MONTHS
Contact your health visitor or GP if your baby is 18-24 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag their leg or foot when crawling or walking
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink
- Find it hard to balance when standing still, or fall over a lot
- Can’t walk by themselves
- Walk on their tiptoes a lot
- Are suddenly unsteady when walking
2 years
2 YEARS
Contact your health visitor or GP if your baby is 2 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your child’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when crawling or walking
- Rarely use one of their arms to play, eat and drink
- Find it hard to balance when standing still or fall over a lot
- Can’t walk by themselves
- Mostly walk on their tiptoes
- Are suddenly unsteady when walking
- Haven’t started to run
- Move from laying down or sitting to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing
3 years
3 YEARS
Contact your health visitor or GP if your baby is 3 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your child’s arms or legs, making it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely uses one of their arms to play, eat and drink
- Find it hard to balance when standing still or fall over a lot
- Can’t walk by themselves
- Mostly walk on their tiptoes
- Are suddenly unsteady when walking
- Have not started to jump or run
- Move from laying down or sitting to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing
4 years
4 YEARS
Contact your health visitor or GP if your baby is 4 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- Find it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely use one of their arms to play, eat and drink
- Find it hard to balance when standing still
- Suddenly become unsteady when walking
- Find it hard going upstairs or uphill
- Trip or fall a lot
- Walk on tiptoes most of the time
- Feel pain in their arms or legs
- Move from laying down or sitting on the floor to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing.
5 years
5 YEARS
Contact your health visitor or GP if your baby is 5 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- Find it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely uses one of their arms to play, eat and drink
- Find it hard to balance, or trip or fall a lot
- Persistently walk on tiptoes
- Suddenly become unsteady when walking
- Feel pain in their arms or legs
- Move from laying or sitting on the floor to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing.
15 months
Your Child By Fifteen Months
Social/Emotional Milestones
- Copies other children while playing, like taking toys out of a container when another child does
- Shows you an object she likes
- Claps when excited
- Hugs stuffed doll or other toy
- Shows you affection (hugs, cuddles, or kisses you)
Language/Communication Milestones
- Tries to say one or two words besides “mama” or “dada,” like “ba” for ball or “da” for dog
- Looks at a familiar object when you name it
- Follows directions given with both a gesture and words. For example, he gives you a toy when you hold out your hand and say, “Give me the toy.”
- Points to ask for something or to get help
Cognitive Milestones (learning, thinking, problem-solving)
- Tries to use things the right way, like a phone, cup, or book
- Stacks at least two small objects, like blocks
Movement/Physical Development Milestones
- Takes a few steps on his own
- Uses fingers to feed herself some food
18 months
Your Child By Eighteen Months
Social/Emotional Milestones
- Moves away from you, but looks to make sure you are close by
- Points to show you something interesting
- Puts hands out for you to wash them
- Looks at a few pages in a book with you
- Helps you dress him by pushing arm through sleeve or lifting up foot
Language/Communication Milestones
- Tries to say three or more words besides “mama” or “dada”
- Follows one-step directions without any gestures, like giving you the toy when you say, “Give it to me.”
Cognitive Milestones (learning, thinking, problem-solving)
- Copies you doing chores, like sweeping with a broom
- Plays with toys in a simple way, like pushing a toy car
Movement/Physical Development Milestones
- Walks without holding on to anyone or anything
- Scribbles
- Drinks from a cup without a lid and may spill sometimes
- Feeds himself with his fingers
- Tries to use a spoon
- Climbs on and off a couch or chair without help
2 years
Your Child By Two Years
Social/Emotional Milestones
- Notices when others are hurt or upset, like pausing or looking sad when someone is crying
- Looks at your face to see how to react in a new situation
Language/Communication Milestones
- Points to things in a book when you ask, like “Where is the bear?”
- Says at least two words together, like “More milk.”
- Points to at least two body parts when you ask him to show you
- Uses more gestures than just waving and pointing, like blowing a kiss or nodding yes
Cognitive Milestones (learning, thinking, problem-solving)
- Holds something in one hand while using the other hand; for example, holding a container and taking the lid off
- Tries to use switches, knobs, or buttons on a toy
- Plays with more than one toy at the same time, like putting toy food on a toy plate
Movement/Physical Development Milestones
- Kicks a ball
- Runs
- Walks (not climbs) up a few stairs with or without help
- Eats with a spoon
2.5 years
Your Child By Thirty Months
Social/Emotional Milestones
- Plays next to other children and sometimes plays with them
- Shows you what she can do by saying, “Look at me!”
- Follows simple routines when told, like helping to pick up toys when you say, “It’s clean-up time.”
Language/Communication Milestones
- Says about 50 words
- Says two or more words together, with one action word, like “Doggie run”
- Names things in a book when you point and ask, “What is this?”
- Says words like “I,” “me,” or “we”
Cognitive Milestones (learning, thinking, problem-solving)
- Uses things to pretend, like feeding a block to a doll as if it were food
- Shows simple problem-solving skills, like standing on a small stool to reach something
- Follows two-step instructions like “Put the toy down and close the door.”
- Shows he knows at least one color, like pointing to a red crayon when you ask, “Which one is red?”
Movement/Physical Development Milestones
- Uses hands to twist things, like turning doorknobs or unscrewing lids
- Takes some clothes off by himself, like loose pants or an open jacket
- Jumps off the ground with both feet
- Turns book pages, one at a time, when you read to her
3 years
Your Child By Three Years
Social/Emotional Milestones
- Calms down within 10 minutes after you leave her, like at a childcare drop off
- Notices other children and joins them to play
Language/Communication Milestones
- Talks with you in conversation using at least two back-and-forth exchanges
- Asks “who,” “what,” “where,” or “why” questions, like “Where is mommy/daddy?”
- Says what action is happening in a picture or book when asked, like “running,” “eating,” or “playing”
- Says first name, when asked
- Talks well enough for others to understand, most of the time
Cognitive Milestones (learning, thinking, problem-solving)
- Draws a circle, when you show him how
- Avoids touching hot objects, like a stove, when you warn her
Movement/Physical Development Milestones
- Strings items together, like large beads or macaroni
- Puts on some clothes by himself, like loose pants or a jacket
- Uses a fork
4 years
Your Child By Four Years
Social/Emotional Milestones
- Pretends to be something else during play (teacher, superhero, dog)
- Asks to go play with children if none are around, like “Can I play with Alex?”
- Comforts others who are hurt or sad, like hugging a crying friend
- Avoids danger, like not jumping from tall heights at the playground
- Likes to be a “helper”
- Changes behavior based on where she is (place of worship, library, playground)
Language/Communication Milestones
- Says sentences with four or more words
- Says some words from a song, story, or nursery rhyme
- Talks about at least one thing that happened during her day, like “I played soccer.”
- Answers simple questions like “What is a coat for?” or “What is a crayon for?”
Cognitive Milestones (learning, thinking, problem-solving)
- Names a few colors of items
- Tells what comes next in a well-known story
- Draws a person with three or more body parts
Movement/Physical Development Milestones
- Catches a large ball most of the time
- Serves herself food or pours water, with adult supervision
- Unbuttons some buttons
- Holds crayon or pencil between fingers and thumb (not a fist)
5 years
Your Child By Five Years
Social/Emotional Milestones
- Follows rules or takes turns when playing games with other children
- Sings, dances, or acts for you
- Does simple chores at home, like matching socks or clearing the table after eating
Language/Communication Milestones
- Tells a story she heard or made up with at least two events. For example, a cat was stuck in a tree and a firefighter saved it
- Answers simple questions about a book or story after you read or tell it to him
- Keeps a conversation going with more than three back-and-forth exchanges
- Uses or recognizes simple rhymes (bat-cat, ball-tall)
Cognitive Milestones (learning, thinking, problem-solving)
- Counts to 10
- Names some numbers between 1 and 5 when you point to them
- Uses words about time, like “yesterday,” “tomorrow,” “morning,” or “night”
- Pays attention for 5 to 10 minutes during activities. For example, during story time or making arts and crafts (screen time does not count)
- Writes some letters in her name
- Names some letters when you point to them
Movement/Physical Development Milestones
- Buttons some buttons
- Hops on one foot
RED
AMBER
AMBER
Green
Advice and Guidance
Top Tips for Helping Your Child with Tooth Brushing
Staying Calm
- Make tooth brushing a fun family activity. Brush your teeth together and make it a positive routine.
- If your child gets upset while brushing, try doing it when they are calmer, like during bath time, or distract them with music or a favourite toy.
- Sometimes, brushing may require two people: one person can distract or comfort your child while the other does the brushing.
- If your child gags or bites down during brushing, try:
- Brushing at a time when they are more relaxed
- Starting with the front teeth and working your way to the back.
- Usiing a second toothbrush as a toy or distraction.
- Gently massaging their face or head to relax them before brushing.
Practical Tips
- Don’t worry if brushing isn’t perfect every time. If it’s difficult, just smear some toothpaste on their teeth and try again later.
- Focus on one area of the mouth at a time to make it easier.
- For younger children, laying them on your lap can help. Alternatively, you can stand behind them or sit with them and support their head. Some children enjoy watching themselves in the mirror during brushing.
- You don’t have to brush in the bathroom - choose a room where your child feels most comfortable.
Sensory Tips
- Let your child play with a toothbrush so they can get used to how it feels.
- If your child doesn’t like the taste or texture of regular toothpaste, try a mild or non-mint flavour, or use a low-foaming, flavourless toothpaste.
Useful Equipment
- There are special toothbrushes that can make brushing easier, like three-sided brushes that clean multiple surfaces at once (see product guide).
- A foam ball on the handle of the toothbrush can help if your child has trouble gripping it.
- Pump-style toothpaste can also be easier to manage.
Extra Help
- If your child has trouble swallowing, try brushing their teeth while they’re sitting up or leaning forward, and use a low-foaming toothpaste.
- In some cases, a toothbrush that attaches to a portable suction machine can help keep your child’s mouth clean.
Myth Busting!
Some people think that if a baby or childdoesn’t eat or drink orally, we don’t need to worry about brushing their teeth.But that’s not true! Even if a baby or child uses a feeding tube, they stillneed to visit the dentist and have their teeth brushed.
It’s important to take care of their mouth and teeth because it helps to:
- Keep their mouth clean and comfortable.
- Stop bad breath.
- Make their mouth feel less sensitive and help their muscles get stronger.
- Remove germs (plaque) from their mouth.
- Lower the chance of getting chest infections.
Top Tips for Visiting your oral healthcare team
Going to the dentist isimportant to keep your child’s mouth healthy. Sometimes, it can feel scary orstrange for kids. Here are some tips to help:
- Find a Dentist: You can look online to find an NHS dentist close to you.
- Talk to the Dentist: Before you go, tell the dental team what you’re worried about so they can help.
- Explain Your Child’s Needs: Let the dental team know what your child likes or doesn’t like, and how they talk or if they need special equipment.
- Prepare Your Child: Help your child understand what will happen. You can show them books or videos to make them feel more ready.
- Visit Before: If possible, visit the dental team before your child’s appointment so it’s less scary. You can also take your child when you have your own check-up, so they can see that everyone goes to the dentist.
- Special Care: If your child needs extra help, they might need to visit a special community dentist or one at a hospital. Your dentist can arrange this if needed.
Further information:
- Patient Info - https://www.bspd.co.uk/Patients/PatientInfo
- British Society of Paediatric Dentistry - Advice for parents of children with autism - Available from: https://www.bspd.co.uk/Portals/0/BSPD%20Advice%20for%20parents%20of%20children%20with%20autism%20Jan%2017.pdf
- A practical guide to children’s teeth - Available from: https://www.bspd.co.uk/Portals/0/A%20Practical%20Guide%20to%20Childrens%20Teeth.pdf
- Smiles for Life - Here is a collection of videos which are presented by Dr Ranj, Hey Duggee, CBeebies and Brush DJ about looking after teeth: https://www.bspd.co.uk/Kidsvids
Self care and Prevention
Video Showcase
Related Conditions
Further Information
