Oral health information for children with enteral tube feeding
Why is oral health important?
Children who have enteral tube feeds may have little or no food by mouth, but a clean mouth is still important.
What common problems do we see?
- Sensitive mouth
- Calculus (tartar) build-up on the teeth
- Gastro-oesophageal reflux – this can cause tooth wear called dental erosion
Why brush your child’s teeth?
Brushing removes ‘dental plaque’, a sticky white film that builds up on the teeth:
- Your child’s mouth will feel more comfortable and may smell better
- Prevents dental plaque becoming hard (calculus), which can then only be removed by a dental professional with special tools
- It will prevent gum problems developing, for example, bleeding gums (gingivitis)
- Brushing stimulates the mouth, improves beneficial saliva flow and reduces hypersensitivity. This can aid oral motor development
- It reduces the risk of chest infections or aspiration pneumonia, if your child is at risk of aspiration
What do I do if my child hates brushing their teeth?
- Try distracting during brushing, for example, playing music, singing
- It’s easier to brush using a toothbrush with a small head
- Try a specialised toothbrush – ask your Dentist for information
- Use rewards or sticker charts for good tooth brushing
Frequently Asked Questions
What should I do if my child is fussy about being touched on or in their mouth?
- For sensitive mouths – start by massaging around the mouth and cheeks using a small soft toothbrush
- Speak to your speech and language therapist for oral desensitisation programme ideas
Would my child aspirate the toothpaste?
- To help limit potential aspiration use a non-foaming toothpaste, for example, Oranurse
- Position your child upright with head tilted forwards or lying on their side
What if my child doesn’t keep their head still?
- Try standing or sitting behind your child, with their head resting on your body
- Remember to support your child’s head during tooth brushing
- There are different positions you can use to clean your child’s teeth – ask your Dentist
What if my child chews on the toothbrush?
- Use a second toothbrush to brush, letting them chew on the other brush
How do I brush my child’s teeth?
- Start brushing your child’s teeth as soon as their first tooth comes through
- Use a toothbrush with a small head
- Use fluoride toothpaste on a dry brush …
Under 3: use a smear of toothpaste containing no less than 1,000ppm fluoride
Over 3: use a pea-sized amount of toothpaste containing at least 1,350ppm fluoride
- Brush for 2 minutes
- Brush your child’s teeth at least twice a day
Before bed time is most important and at least one other time
- Get your child to spit, but do not rinse out. If they cannot spit, gently wipe mouth after brushing (do not use water). This will keep fluoride in the mouth to strengthen the teeth
- Help your child with tooth brushing until they are at least 7 years old
- Brushing can be challenging – see our Frequently Asked Questions section above or speak to your Dentist for tips
What are tips for a healthy mouth?
- Oral food or drink. If your child has been assessed by a speech and language therapist to be able to have any food or drink by mouth safely, even if this is tiny tastes on their lips, try to limit the number of times a day where you can – to prevent dental decay.
- If your child has been assessed to take liquids orally safely, give them plain water or milk to drink.
- In the hour before bed avoid eating and drinking, except plain water
- Ask for sugar-free medicines (if taken by mouth)
- Visit a Dentist – to help your child get used to dental check-ups and for personalised advice for your child. All children should see a dentist before their first birthday
Clinical Lead for Paediatric Dysphagia (Feeding and Swallowing): Jane Shaw
Sheffield Children’s Hospital
0114 271 7452
Is something missing from this resource that you think should be included? Please let us know
Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.