GOOD PRACTICE GUIDE
Oral Health Promotion in Early Years Settings
Contents
2
Foreword / Acknowledgements
05
Introduction
06
Section 1: Fluoride
08
Section 2: Oral Hygiene
10
Section 3: Diet
12
Section 4: Regular Dental Care
16
Section 5: Dummies
18
Section 6: Oral care for expectant and nursing mothers
20
Section 7: Models for good practice:
22
i) Four Key Oral Health Promotion Messages
22
ii) Oral Health Training
22
iii) Dental Resource Box
24
iv) Dump the Dummy and Bin the Bottle
25
v) Weaning Programmes
26
vi) Healthy Eating Policy
28
vii) Healthy Eating Sessions
30
viii) Promotional Events
32
ix) Dental Visits
32
x) Family Support
33
Section 8: Useful Contacts / Resources
34
Section 9: References
35
3
4
Foreword
Contact details
The Good Practice Guide for Oral Health Promotion
in Early Years settings is a result of the close working
relationship that exists between the Oral Health
Promotion Teams, the management of the Early
Years settings and most importantly those who work
in the centres and use the centres on a daily basis.
Finding a dentist
The condition of young children’s teeth in Liverpool
and Sefton remains a cause for concern. By the time
they are 5 years old, almost half of our local children
will have developed tooth decay. There are wide
variations in child dental health across the area with
some localities having more than double the levels
of child dental decay compared to others.
Tackling the problem of poor child dental health
requires all who live and work with young children
to play a part, and promote the simple messages
that can make a big difference to keeping teeth
healthy. These are focussed around encouraging
toothbrushing with family fluoride toothpaste,
healthy eating and visiting a dentist early for
additional preventive treatment and advice.
The Good Practice Guide helps you translate key
dental health messages into actions in the Early
Years setting. The Guide gives you key information
about dental care and also practical advice and
examples of good practice in action which I hope
you will find useful. Your comments and feedback
on the Guide are very welcome, as are any ideas
or examples of good practice which can be shared
via future updates.
Thank you for taking the time to read the Guide
and for your support and continued work towards
ensuring that children in Liverpool and Sefton have
healthy and happy smiles.
To find a dentist you could use personal
recommendation or contact:
• NHS England
0300 311 2233
Alternatively visit the NHS Choices website
www.nhs.uk
Directorate of
Community Dental Health
Provides dental care for children and vulnerable
groups on referral. Contact the main office at:
Hartington Road Family Health Centre
Lesseps Road
Liverpool
L8 0SG
tel: 0151 295 8640
Oral Health Promotion Team
For advice and support on dental health
education and promotion. Contact:
Helen Parsley
Principal Dental Health Promotion Officer
Hartington Road Health Centre
Lesseps Road
Liverpool
L8 0SG
tel: 0151 295 8640
email: [email protected]
Lesley Gough
Consultant in Dental Public Health
Liverpool PCT, NHS Sefton, NHS Knowsley
5
Introduction
This Good Practice Guide has been developed by the
Directorate of Community Dental Health for Liverpool
and Sefton in consultation with parents and key staff in
Early Years Settings.
It is designed to enable staff who work within an early
years setting promote oral health. It can be used as a
‘reference for good practice’ and/or a benchmarking tool.
For ease of use, sections 1 to 6 offer the current
evidence base for oral health practice within the early
years setting and practical tips for application.
Evidence Base
Evidence Base
Common risk factor approach…
A number of chronic diseases have risk factors in
common with each other.
• Key factors leading to poor oral health are risk
factors for other diseases, so oral health should
not be isolated and marginalised from general
health.2
• In line with this approach is the integration
of oral health promotion into the wider public
health agenda for example: smoking, alcohol
misuse, obesity and mental health.2
Key evidence based information is presented
in this format.
Practical Tips
Practical advice for its application in the early
years setting is presented in this format.
Section 7 details information, suggestions and
ideas for good practice within the early years
setting addressing the themes, principles and
commitments of the early years curriculum.
‘Oral Health is a standard of health of the oral and
related tissues which enables an individual
to eat, speak and socialise without active disease,
discomfort or embarrassment and which
contributes to general well-being.’3
Oral health plays an important part in a child’s
It is generally accepted that dental hygiene
patterns adopted at an early age tend to persist
into adult life.2
People’s patterns of behaviour are often set
early in life and influence their health through
out their lives.1
Infancy, childhood and young adulthood are
critical stages in the development of habits that
will affect people’s health in later years.1
6
7
The fluoride in toothpaste serves to
prevent, manage and stop the progress
of tooth decay.
Fluoridation of the water supply is a safe
and highly effective public health measure.8
Practical Tips
Evidence Base
Fluoride schemes in Children Centres.
At present there is no fluoride added
to Liverpool’s or Sefton’s water supply.
• It is good practice to apply luoride in the form
of toothpaste containing the optimum level of
fluoride (1000ppm–1450pmm) on the teeth of
young children.
• This should be done on a daily basis within
the nursery setting, with parental consent.
Evidence Base
Fluoride brushing schemes – what are
the benefits?
• Children who start brushing in infancy are less
likely to experience tooth decay than those
who start later.2
• Evidence shows that the application of
toothpaste containing the optimum amount
(1000ppm to 1450ppm) of fluoride provides
significant benefit for high caries risk children
living in deprived, non fluoridated districts.4
• This is an early intervention and effective
protection scheme.5
Evidence Base
Fluoride Varnish - what is the benefit?
Fluoride varnish is one of the best options for the
application of topical fluoride to teeth. It has a
number of practical advantages; it is well accepted
and considered safe, the application is simple,
and it requires little training.
High quality evidence of the caries preventative
effectiveness of fluoride varnish in both
permanent and primary dentitions is available.13
8
Water fluoridation
• Currently approximately 10% of England’s
population (about 6 million people) benefit
from a water supply where the fluoride content
either naturally or artificially is at the optimum
level for dental health.6
• In 2003 the law was changed enabling strategic
health authorities to require water companies
to fluoridate water supplies providing there is
support from the local population following
consultation.7
Brushing for Life
This programme promotes the use of a family fluoride toothpaste.
The dental health packs are distributed by Child Health teams.
A dental health pack is provided at a child’s 6-9 month and 18-24 month developmental checks.
Each pack contains a toothbrush, family luoride toothpaste and information about child dental health.
In addition, parents are given a free-low infant feeder cup at the 6-9 month visit.
Another pack is distributed by School Nurses at the Pre School Entry Assessment.
This programme is co-ordinated by the Directorate of Community Dental Health.
9
2: Oral Hygiene
The fluoride in toothpaste serves to
prevent, manage and stop the progress
of tooth decay.
Evidence Base
Practical Tips
Higher concentration fluoride toothpaste
gives better protection against tooth decay.9
Advice for parents:
Evidence Base
• Brush before bedtime and on one other
occasion during the day using a family
fluoride toothpaste.
Toothbrushing: Clean the teeth thoroughly
twice every day with a family fluoride toothpaste.
• Effective daily toothbrushing with a fluoride
toothpaste is the best way of preventing both
caries (decay) and periodontal (gum) disease.8
• Thorough brushing of all tooth surfaces and
gum margins twice a day is of more value than
more frequent cursory brushing, and a gentle
scrub technique should be advised.8
• A small soft-to-medium texture toothbrush
should be used to allow all tooth surfaces
and gum margins to be cleaned easily
and comfortably.8
• Effective toothbrushing with a family fluoride
toothpaste will help control caries (decay)
provided that the diet is also favourable.8
10
• Brush your child’s teeth on a daily basis
as soon as they appear.
• Start with a smear of paste on the brush
and move on to a small pea sized amount
when the child is three years old.
• Make sure that all the tooth surfaces
and gums are brushed.
• Use a small headed soft toothbrush
and replace when the bristles become splayed.
• Brushing should be supervised until the age
of six or seven years.
• Spit don’t rinse!
• Support water luoridation.
11
3: Diet
Key dietary messages to prevent tooth decay
are summarised throughout this section.
Routine healthy eating practices within the early years
setting will help to promote good oral and general
health in young children.
Evidence Base
Reduce the consumption and especially the
frequency of intake of drinks, confectionery
and foods with sugars.
• The consumption of sugars, both the frequency
and the amount, is important in determining
the rate of tooth decay.8
• When sugars are consumed they should be
part of a meal rather than between meals.8
• Snacks and drinks should be free of added
sugars, whenever possible.8
• The frequent consumption of acidic drinks
(such as fruit juice, squashes or carbonated
drinks) should be avoided to help prevent
dental erosion.8
Practical Tips
• Avoid giving biscuits or sweets as treats
or rewards.
• Never dip dummies into sweet products
such as honey, jam, syrup.
• Although dried fruits count as one of your
‘five a day’, they can cause tooth decay
so restrict to meal times.
• Yoghurts and fromage frais can contain
a lot of sugar.
Practical Tips
• Always read labels… ‘no added sugar’ or
‘low sugar’ …may still contain some sugars.
• Look out for hidden sugars… sucrose, fructose,
glucose & honey …are all types of sugars.
12
Drinks
A child’s normal fluid intake should ideally be plain
water or milk. Children do not need to be offered
juice as an alternative.
Evidence Base
• ‘Parents and carers should be specifically warned
against the practice of allowing prolonged
drinking from a bottle, feeder or any other
type of lidded feeder cup of any sugared drink,
including carbonated drinks, fruit–based juices,
squash and natural fruit juice’.8
13
3: Diet
Early childhood caries
Prolonged drinking of sugar containing drinks from a
feeding bottle or cup is well recognised as a cause of
the rapidly processing decay called ‘early childhood
decay’.
Evidence Base
• As recommended by the Department
of Health, exclusive breast feeding is
recommended for the first six months of
a child’s life.
• The best drink for the first year of life is
breast milk or formula milk.
• Full fat cow’s milk can be introduced from
one year.
• Encourage breast feeding for as long
as possible.10
Practical Tips
Support breast feeding mothers by:
Practical Tips
• A free-low feeder cup can be introduced
at six months (weaning).
• Giving juice is not necessary, however if you
choose to do so, make sure it is well diluted
(1:10) and given at mealtimes only.
• Keep drinking times short.
• Feeding bottles should be discouraged after
twelve months.
• Never give juices in a feeding bottle – only
milk or water.
• Never let your child go to bed with a bottle.
• Never leave a child unsupervised with a bottle.
Although fruit and/or vegetable smoothies
are a healthy contribution to your ‘five a day’,
they can cause tooth decay so should ideally
be consumed as part of a meal.
14
• Offering them the opportunity to breastfeed
when they wish.
• Encouraging them to bring expressed milk
in a cool bag.
• Ensure expressed milk is labelled with the
date and name of infant, and stored in the
main body of the fridge.
Erosion
Weaning
Fizzy and fruit based drinks contain acid
which can damage teeth by ‘dissolving’ the
outer layer (enamel). This is called ‘tooth
erosion’.
The Department of Health recommends that
children begin to be weaned at six months.
Practical Tips
• Carry on giving breast or formula milk
as the main drink.
• Start with small amounts of pureed food,
gradually increasing the consistency
and amount.
• Don’t add sugar or salt.
• For more information please ask parents to
speak to their Health Visitor.
Evidence Base
• Limit the frequency of intake of
acidic beverages.
• Avoid brushing for one hour after
an ‘acidic episode’.8
Medicines
Many liquid medicines contain large amounts of sugar.
Practical Tips
Promote the use of ‘sugar free’ medicines.
Evidence Base
• The use of sugars in medicines should be
strongly discouraged and sugar-free liquid
medicines should be chosen by prescribers and
when buying non-prescription medicines,
whenever possible.8
• If children have a long-term medical
condition, parents and carers should request
clinicians to prescribe sugar-free liquid
medicines or preferably tablets instead
of liquids.8
15
4: Regular dental care
Prevention is better than cure. NHS dental
treatment is free for children under the age
of eighteen.
Evidence Base
• Children should be encouraged to visit a
dentist as early as possible.8
• Children under 18 years will need a dental
examination every 3 to 12 months
(as determined by their dentist).8
• Attendance will enable the health of the whole
mouth to be monitored and appropriate dental
health advice and early treatment to be
provided when needed.8
Practical Tips
• When children are enrolled at nursery you
may wish to ask their parents if they have
a dentist.
• To find a local NHS dentist contact NHS
England on 0300 311 2233
For local information on finding an NHS Dentist,
plus lots of other information about Dental Health
Introducing the North West Dental Health website.
We have an exciting range of information and
resources on dental health. All our information is
based on the latest scientific evidence base so that
you know that it is sound and accurate.
The website aims to provide useful information on
dental health both for the general public and health
professionals. Since first developing this website
a few years ago, we have been pleased to see the
work of the primary dental care team focus more on
the provision of preventative dental care and advice.
We hope that the information and resources available
through this site will be helpful to colleagues working
in general dental practice as well as those of you who
have supported dental health programmes in local
communities over the years.
Lesley Gough
Consultant in Dental Public Health
Liverpool PCT, NHS Sefton, NHS Knowsley
• In an emergency contact :
• Liverpool 0151 300 8349
• Sefton
01704 548 863
• Knowsley (weekdays ) 0151 244 3250
• Knowsley (evenings) 0151 300 8349
• Knowsley (weekends) 0151 285 3767
www.northwestdentalhealth.nhs.uk
16
17
Key evidence based messages relating to the
use of dummies are included in this section.
Evidence Base
Many parents use a dummy as a way of
comforting their baby, especially when trying to
get their child off to sleep.
• Limited use of dummies is fine, but if a child
sucks on a dummy for long periods, it could
cause problems in the way the teeth develop.
• The same is true if a baby sucks his or her
thumb.
• The pressure of the thumb or dummy against
the back of the teeth could push them
forward, which may mean a child will need
corrective treatment – like a brace or having
teeth removed – later on.
• Never be tempted to dip a child’s dummy in
anything, especially something like sugar or
fruit juice. Prolonged contact with the teeth
could cause real damage.
• Use of a dummy appears to reduce the risk of
SIDS (Sudden Infant Death Syndrome) and may
also reduce the impact of known risk factors in
the sleep environment.11
18
Dummy
Using a dummy every time you settle your baby to
sleep (day and night) can reduce the risk of cot death.
If breastfeeding, do not begin to give a dummy until
your baby is one month old to ensure breastfeeding
is well established. Don’t worry if the dummy falls
out while your baby is asleep, and don’t force them
to take a dummy if they don’t want it. Never coat the
dummy in anything sweet. Gradually wean him off a
dummy after six months and before one year.
For more information or to have your questions
answered call us free on 0808 802 6898, email
[email protected] or visit www.fsid.org.uk
Foundation for the Study of Infant Deaths
11 Belgrave Road
London
SW1V 1RB
19
6: Oral care for expectant and nursing mothers
Evidence Base
Evidence Base
Twice daily effective brushing with a family fluoride
toothpaste is very important during pregnancy.
NHS Dental treatment is free whilst pregnant and
remains free until the child is one.
• Many women find their gums bleed when they
are pregnant, due to hormonal changes. This is
known as ‘pregnancy gingivitis’.
• It is important to have a dental check
whilst pregnant.
• It is caused by dental plaque which irritates
the gum margin if not brushed away effectively.
• Gingivitis presents as inflammation of the gum
margin, with redness, swelling and bleeding
on brushing.
• During pregnancy, even a modest deposit of
plaque can cause irritation.8
Practical Tips
• During pregnancy the diet should provide
enough energy and nutrients for the baby to
grow and develop, and for the mother’s body
to deal with the changes taking place.
• A breastfeeding mother should try and eat a
varied and balanced diet (some families may be
eligible for the ‘Healthy Start’ Scheme).
• Your Midwife and Health Visitor will be able
to advise.
• When pregnant it is even more important
to maintain good oral hygiene.
• Regular dental visits should be encouraged.
20
• The maximum time between dental checks for
an adult should be two years, but many
people may need to be seen more frequently.
This is determined by a number of factors,
for example: oral health status, lifestyle,
pregnancy.8
21
7: Models for good practice
Information, suggestions and ideas for good
practice within the early years setting.
i) To promote good oral health there
are four key messages:
1. Fluoride:
Fluoridation of the water supply is a safe and highly
effective public health measure.
• Water luoridation should be targeted at
communities with higher caries levels.
• Where it is not technically feasible other
fluoride strategies should be employed, such
as programmes to promote the use of fluoride
toothpaste and the application of fluoride varnish.
2. Toothbrushing:
3. Diet:
Reduce the consumption and especially the frequency
of intake of drinks, confectionery and foods with
sugars.
• The consumption of sugars, both the frequency and
the amount, is important in determining the rate of
tooth decay.
• When sugars are consumed they should be part
of a meal rather than between meals.
• Snacks and drinks should be free of added
sugars, whenever possible.
• The frequent consumption of acidic drinks such
as fruit juice squashes or carbonated drinks
(even diet drinks) should be avoided to help
prevent dental erosion.
Clean the teeth thoroughly twice every day with
a fluoride toothpaste.
4. Dental attendance:
• Effective daily toothbrushing with a family
fluoride toothpaste is the best way of preventing
both caries (tooth decay) and periodontal disease
(gum disease).
• Everyone, irrespective of age and dental
condition, should have an oral examination
approximately once a year so that cases of oral
cancer or other diseases can be detected early
and treated.
• Other oral hygiene aids such as loss and
interdental (between teeth) brushes are best
used after they have been demonstrated by
a dentist, therapist or hygienist.
• Thorough brushing of all tooth surfaces
and gum margins twice every day is of more
value than more frequent cursory (brief)
brushing, and a gentle scrub technique should
be advised.
• A small soft-to-medium texture toothbrush
should be used to allow all tooth surfaces
and gum margins to be cleaned easily
and comfortably.
• Effective toothbrushing with a family fluoride
toothpaste will help control caries provided that
the diet is also favourable.
22
Have an oral examination every year.
• This advice also applies to those without any
natural teeth.
• Children and those at risk from oral disease,
e.g. smokers, may need to be seen more
frequently, as advised by the dentist.
ii) Oral Health Training
There is a need to equip better the wider
healthcare workforce to deliver improved
oral health. 2
Oral Health training sessions are offered to all Early
Years settings. The training session is open to all core
staff, key workers, stakeholders, partner agencies,
volunteers and service users, or as directed by
managers.
These sessions provide an ideal opportunity for staff
from different establishments to come together and
share their experiences (good and bad). A holistic
multi-disciplinary approach is needed to deliver better
outcomes for children and their families. Some staff
may be unaware of the important role they can play in
helping to promote oral and general health to children
and their families.
Staff could possibly be the first point of contact, for
instance, if staff members are able to provide details
of the Patient Advice and Liaison Service (PALS) they
are helping to facilitate access to primary dental care.
The session aims to encourage policy development
within the remit of both dental and general health. This
enables staff to promote oral health on a day-to-day
basis integral to the establishment’s core programmes.
Topics covered are:
• Benefits of fluoride.
• Cause and prevention of caries (tooth decay) and
gum disease.
• The wider public health agenda.
The training session enables attendees to give
evidence based advice to parents, guardians or carers.
For example, if they were approached with regard to
advice about dummies, the staff member will know
that it is important not to dip dummies into sugary
substances.
Staff attending the training session receive a
certificate of attendance for their personal
portfolio. This can help towards evidence for
continual professional development.
Some comments made on past evaluation
forms:
E a led
e to etter i for
pare ts.
Good practical advice, welcomed advice
on policies covering de tal health.
Reall interesting i for atio .
All of the information was relevant and
pra ti al.
• Putting theory into practice.
I will look into parental agree e ts.
• Effective use of available resources – Structured
Dental Resource Box.
I am more confident about giving out ad i e.
Will try to encourage parents to bring fruit
instead of s eets.
The sessio was very useful.
Resour e box is a good idea.
Very helpful.
23
7: Models for good practice
iii) Dental Resource Box
Early Years Curriculum
The Dental Resource Box can be used to
address aspects of the early years curriculum.
Such as:
• A Unique Child.
• Positive Relationships.
• Enabling Environments.
• Learning and Development.
• Child Development
• Health and Wellbeing
• Play and Exploration
• Active Learning
Activities can be linked to the principles and
commitments of each theme. The Dental Resource
Box can be used to address ‘Health and Bodily
Awareness’ in relation to ‘Physical Development’.
For example, going to the dentist for a check up.
The Dental Resource Box was launched in 2002 and
targeted at early years establishments to help carers
promote oral and general health. The box contains
items that promote discussion around diet,
toothbrushing, regular dental attendance, and the
shape and types of teeth. Examples of contents
include: puzzles, storybooks, activity sheets, crocodile
puppet with teeth. The dressing up outfits encourage
role-play, which can be centred around dental checks
etc. Masks, gloves, x-ray cards and appointment cards
also contribute to role-play.
A number of Children Centres have purchased their
own additional Dental Resource Boxes!
Loaning the Dental Resource Box
Staff can make a request to loan the resource
box via the oral health promotion early years team.
The resource will be delivered and collected at
a convenient time.
The loan of the Dental Resource Box is usually offered
to early years settings after key staff have attended
one of the oral health training sessions delivered by
the early years oral health promotion team.
The dental resource box is introduced and learning
outcomes for each item are discussed.
At the end of the loan period, staff are asked to
complete and return a evaluation form so we can
gain valuable feedback and develop our resources
to address the needs of early years settings.
Some comments from completed
evaluation forms:
The children really got into the spirit of thi gs.
The children loved the stor
ook.
Childre enjoyed using the resource o .
Good role-play resour e.
We really enjoyed the o .
The box included lots of interesting ite s.
We made a play about the dentist and showed
it to the hildre .
It underpinned some great discussions on
healthy foods.
Posed plenty of opportunity to talk about who
helps brush their teeth.
24
iv) Dump the dummy and bin the bottle
Dump the dummy/bin the bottle is a local project aimed
at toddlers to encourage them to give up their dummy
or bottle. These sessions can be linked into other family
sessions that are held.
Opportunities to ‘Dump the Dummy’ and/or ‘Bin the
Bottle’:
• Both can be incorporated into relevant cultural
festivals and community events e.g. Christmas,
Easter, Diwali, Hanukah etc.
storybooks, comics and rhyme CD’s make good rewards
as they encourage speech development.
When a child has ‘binned their bottle’ replace it with
a free-flowing feeder cup. If a child isn’t ready to bin
their bottle offer encouragement and suggest trying at
a later date.
Emphasis should be on not putting sweetened drinks
into a feeding bottle, reducing frequency, and keeping
drinking times short.
• Plant the dummy/bottle in the garden along with
some flower seeds, and watch a flower grow.
• The child could go into the baby room in nursery and
‘give’ the dummy/bottle and/or bottle to the babies
in there – as they are growing up (have a bin ready
to put them into for cross infection purposes).
• Hold a dummy/bottle trail – parents and children fi
the hidden dummies/bottles around the building.
All activities should be focused around dummies/
bottles – stories, games, pictures, etc.
When children have dumped their dummy, reward
them with a present or certificate to take home –
25
7: Models for good practice
v) Weaning Programmes
The oral health promotion team have helped to
develop and facilitate several weaning programmes.
The main aim of a weaning programme is to
introduce good eating habits as early as possible.
Programmes generally run over a four week period,
two hours once a week.
All sessions are designed to incorporate Department of
Health guidance, as found in:
• Guidelines for Weaning.
• Five-a-Day Programme.
• Choosing Health.
• Choosing Better Oral Health.
Each session gives parents the opportunity to gain
practical experience and gain theoretical knowledge.
Parents are encouraged to participate in food
demonstrations for each stage of weaning.
Tips for facilitators
• Print out recipes for each stage of weaning.
• Ask other health professionals to come into the
group as a guest speaker.
• If funds are available, purchase hand blenders
and give out to parents. This would enable
parents to follow the recipes at home.
26
EXAMPLE
Week 1
Why and When to Wean
Introduced through pre knowledge
questionnaires for parents to answer.
A group discussion can be facilitated
around the answers.
Health and Safety
Group discussion about safety in the kitchen,
eg. locks on cupboards, sockets covered, fire/
smoke alarms, stair gates, pan handles, flexes,
oven rings, keep toys out of the kitchen, etc.
Food Hygiene
Group facilitators ideally should possess a basic
food hygiene certificate. Focus on clean work
surfaces and utensils, preparing and freezing
food, fridge temperatures, appropriate placing
of food in the fridge.
Dental Health
An opportunity to focus on the main dental
health messages around diet, toothbrushing
with a family fluoride toothpaste, regular
dental attendance.
Week 3
Second stage of weaning
Moving from mashed to lumpy foods. Group
discussion around suitable and unsuitable foods.
Whole milk can be mixed with food.
Start to introduce meat, bread, etc.
Introduce drinking from a free-flow feeder cup.
Encourage children to sit down and eat.
Week 2
First stage of weaning
Introduction of first foods/small amounts.
Group discussion around suitable and
unsuitable first foods e.g. honey. Not to be introduced
before the age of one. Breast/formula milk is main
source of nutrients.
Baby rice – mix with breast/formula milk.
Week 4
Last stage of weaning
At the last stage of weaning children should
be eating similar food to parents.
Some parents may have started to wean
their babies by week 4.
Include a group discussion sharing
weaning experiences, etc.
Purees/mashed food:
• ideal first food
• can be mixed with breast/formula milk
• introduce one at a time
• introduce savoury foods before sweet foods.
Incorporate a practical demonstration – prepare a
meal such as home made cauliflower cheese.
Don’t add salt or sugar during preparation.
Re-inforce all previous week’s messages.
27
7: Models for good practice
vi) Healthy Eating Policy
By developing a healthy eating policy you are
encouraging good eating habits from an early age.
When developing a healthy eating policy, it is important
to involve as many people as possible in the process.
This may include parents, volunteers and staff. The
policy may encourage healthy eating habits via good
practice within your early years setting.
Try to think about areas of concern (e.g. party bags)
that have occurred in the past. Or just make a few day
to day observations.
Remember the aim is to promote the good health of
the children.
Examples which you may wish to include
in your policy are:
• Not allowing fizzy drinks and offering healthier
alternatives such as milk or water.
• Discouraging sweets, lollipops or chocolates.
• Discouraging sugar sweetened drinks in a
feeding bottle.
Events such as Birthdays, Easter, Christmas and other
religious festivals often attract sugary treats.
The issue of party bags can be addressed by parents/
guardians/carers signing an agreement which states
that they agree to adhere to the healthy eating policy.
In line with the policy, the above would be allowed to
bring in a cake for the children to enjoy as part of their
meal rather than bringing in party bags.
The Caroline Walker Trust publish nutritional
and practical guidelines on healthy eating
for specific groups (eg. under 5’s), which
may be useful when developing your policy!
The Caroline Walker Trust
22 Kindersley Way
Abbots Langley
Herts.
WD5 0DQ
[email protected]
28
29
7: Models for good practice
vii) Healthy Eating Sessions
Oral health is central to healthy living and a key marker
of the health of the community.
If your establishment facilitates a healthy eating
session, this is an ideal opportunity to introduce
and discuss oral health.
• Ingredients used to prepare food during
the session may contain hidden sugar.
• Manufactured food may contain high
proportions of added sugar, this is generally
for shelf-life purposes.
• When discussing sugar content, advise the
parents/families to look at ingredients labels.
• Anything ending in ‘OSE’ is a type of sugar
and would increase the risk of developing
tooth decay.
• Sugar is often found under the
CARBOHYDRATE’ content.
• Ingredients: the higher on the list an
ingredient is, the more the product contains.
The Food Standards Agency (FSA) traffic light system
is an easier way of identifying healthier foods when
out shopping.
Food products with traffic light labels on the front
of the pack show you at-a-glance if the food you
are thinking about buying has high, medium or low
amounts of fat, saturated fat, sugars and salt, helping
you get a better balance:
RED = HIGH
FOOD STANDARDS AGENCY
LOW
LOW
HIGH
AMBER = MEDIUM
GREEN = LOW
30
MED
TOPICS FOR DISCUSSION:
Dried fruit:
Dried fruit contains high levels of sugar.
The Department of Health recommends dried
fruit as a way of achieving one of your ‘five-a-day’
requirements.
Getting young children to drink water:
Water is an inexpensive healthy drink that all the
family can enjoy, it is also safe for teeth.
To encourage children to consume water,
try putting a jug of water in the fridge to cool.
However, snacking regularly on dried fruit could
increase the risk of developing tooth decay, so it
is recommended that dried fruit is only consumed
at mealtimes.
Juice:
Concentrated fruit juices contain high levels of
sugar. For this reason, juices are best consumed
at mealtimes.
Remember to dilute at a ratio of 1 part juice to
10 parts water (1:10).
Emphasis should also be focussed on not putting
sugar sweetened drinks into feeding bottles, using
a free flow feeder cup and keeping drinking times
short.
Smoothies:
Smoothies contain high levels of sugar which
has been extracted from the fruit, thus consuming
these too often could increase the risk of
developing tooth decay.
Soya Products
These often contain large amounts of sugar.
If these products are needed, always endeavour
to buy the unsweetened versions.
Smoothies are healthy and exciting to prepare
but because of their high sugar they should be
limited to mealtimes (they make a great breakfast
or pudding).
31
7: Models for good practice
viii) Promotional Events
The Oral Health Promotion team participate in
promotional events throughout the year. As well as
promoting oral/general health, these events are also
an ideal opportunity to work with multi-disciplinary
agencies sharing up to date evidence based
information and good practice.
National Smile Month
The Oral Health Promotion team take part in many
promotional events, National Smile Month (May),
is a specific opportunity to promote oral health
and well being.
The campaign aims to improve people’s
understanding of the importance of maintaining
good oral care. Each year, a different oral health
theme is chosen by the British Dental Health
Foundation to highlight and raise awareness
of specific oral health issues. The oral health
promotion team liaise with staff from various
settings to disseminate ideas, information and
resources around the national theme or a locally
tailored theme.
Many early years settings choose to promote
oral health during National Smile Month by
purchasing oral health promoting packs
which contain:
• a toothbrush
• family fluoride toothpaste (1000 – 1500ppm)
• information leaflets
• colouring sheets/stickers
The packs ensure that parents and children within the
local community are receiving basic oral health tools
and accompanying advice.
Other activities may include, ‘Dump the Dummy’,
‘Bin the Bottle’ and ‘Toothbrush Exchange’ (replacing
old worn brushes with new ones), etc.
The oral health promotion team are available to
offer oral health advice or discuss any concerns
a parent, carer or staff member may have!
ix) Dental Visits
Trips can be arranged for children from early years
and school settings to visit a local dental practice or
community clinic to address the issue of ‘visiting the
dentist’.
During the visits, children are given the opportunity to
wear gloves and masks, play with torches and mirrors
and have a ‘ride’ in the dental chair.
These visits can be of particular benefit to children
who have never attended a dental surgery before, or
children who may have had a particularly unpleasant
experience (such as general anaesthetic), and can
be used to help diffuse fears and uncertainty on
future visits.
Members of the dental health promotion team
work closely with community and general dental
practitioners.
Sessions can be arranged by early years staff or through
the Oral Health Promotion team.
32
x) Family Support
Good oral health is important when we consider
self-esteem and confidence. This should be taken into
consideration when working with families within the
local area, addressing key issues around social and
emotional support.
Advice and support can be given to parents who
attend your early years setting and other outreach
sessions you support. This may be offered in a number
of ways, for example:
• one-to-one support (family appointment)
• group intervention (educational groups /
support groups)
• leaflets
• displays/exhibitions/promotional events
• oral health activities (toothbrush exchange,
puzzles etc.)
Linking oral health to the
Early Years Curriculum
Health and Well-being
Facilitating access to dental services / providing
parents with information to enable them to make
an informed choice.
Child Development
A skilful communicator and a competent learner.
Active Learning
Professional relationships and shared care.
Play and Exploration
Utilise the structured dental resources box,
encouraging role play.
In line with ‘Choosing Health’, the
following issues can be addressed:
• improving diet
• improving oral hygiene
• optimising exposure to fluoride
• dental attendance
• tobacco and alcohol control.
33
Finding a dentist
To find a dentist you could use personal
recommendation or contact:
• NHS England
0300 311 2233
Alternatively
NHS Choices website
www.nhs.uk
Directorate of
Community Dental Health
Provides dental care for children and vulnerable
groups on referral. Contact the main office at:
Hartington Road Family Health Centre
Lesseps Road
Liverpool
L8 0SG
tel: 0151 295 8640.
Oral Health Promotion Team
For advice and support on dental health
education and promotion. Contact:
Helen Parsley
Principal Dental Health Promotion Officer
Hartington Road Health Centre
Lesseps Road
Liverpool
L8 0SG
tel: 0151 295 8640
email: [email protected]
34
• The North West Dental Health website -
An exciting range of information and resources
on dental health. All information is based on
the latest scientific evidence.
www.northwestdentalhealth.nhs.uk
• British Dental Health Foundation has key
points for improvement of dental health.
www.dentalhealth.org.uk
• The Dental Observatory has information both
for adults and children for maintaining good
dental health. It also contains up to date
information on the current levels of decay in
the region.
www.dental-observatory.nhs.uk
• Royal College of Surgeons, faculty of dental
surgery. Produce up to date guidelines on
appropriate treatment for patients.
www.rcseng.ac.uk/dental/fds/
clinicalguidelines
• Food Standards Agency website. Gives general
healthy eating guidelines which correlate with
dental dietary advice.
www.food.gov.uk
• The Caroline Walker Trust. Dedicated to the
improvement of public health through good
food. Produces expert reports which
establish nutritional guidelines for vulnerable
groups – including children and older people.
www.cwt.org.uk
• British Dental Association.
www.bda.org
References:
1. Department of Health (2004)
Choosing Health, Making Healthy
Choices Easier – DH
2. Department of Health (2005)
Choosing Better Oral Health, An Oral Health
Plan For England – DH
3. Department of Health (1994)
An Oral Health Strategy for England – DH
7. Her Majesty’s Government (2003)
Water Act 2003 – HMSO
8. Levine,R and Stillman-Lowe,C (2009)
The Scientific Basis of Oral Health Education
(6th edition) – BDJ Books
09. Department of Health/BASCOD (2014)
Delivering Better Oral Health, An Evidence
Based Toolkit for Prevention – DH
4. Davies G M, Worthington HV, Ellwood RP, et al
(2002)
A randomised controlled trial of the effectiveness
of providing free flouride toothpaste from the age
of 12 months on reducing caries in 5-6 year old
children
– Community Dental Health Vol 19, No 3.
10. Department of Health (2009)
Birth To Five – DH
5. Department of Education and Skills (2004)
Every Child Matters, Change For Children
– DFES
12. Foundation for Sudden Infant
Death Syndrome (SIDS)
(online) www.fsid.org.uk
6. Jones,S and Lennon,K (2004)
One in a Million (2nd edition)
– British Fluoridation Society
(online) www.bfsweb.org
13. Marinho VCC, Higgins JPT, Logan S
and Sheiham (2002)
Fluoride varnish for preventing dental caries
in children and adolescents
- Cochrane Database
of Systematic Reviews,CD 002279
11. British Dental Association (2009)
Common Problems, Dummies
and Thumb Sucking
(online) www.bdasmile.org
35
The information within this leaflet was correct at the time of going to press.
Comments and suggestions on how the service
can be developed are welcome.
For further information please contact:
Directorate of Community Dental Health
Hartington Road Clinic
Lesseps Road
Liverpool
L8 0SG
Tel: 0151 295 8640
MOGP01
Revised 01/15