Keeping Those Little Teeth Healthy

Following up on last week’s theme of keeping your parenting fun, let’s talk about a topic that is not inherently fun: Children’s oral health. Yup, you are in charge of helping your children to grow strong teeth with a healthy diet and maintain those strong teeth with good dental hygiene. Genetics certainly plays a strong role, but there is so much you as a parent do to set your kids up with a healthy mouth that will benefit them for decades, maybe even a century, hereafter. If you have ever had a cavity, you know that a) they can be painful, b) they require some unpleasant treatment, and c) they require a lifetime of dental follow-up because filling materials degrade and need to be replaced, each time having the risk of losing more of the original tooth and inching you closer to all of those awful words like dentures, bridges, crowns – all those scary dental issues I am so glad I have never had to deal with and will do anything I can to keep my kids from encountering them.

First, the basics….When should you start taking care of your child’s teeth? As soon as they’re born. Yup, get one of those little rubbery thoothbrushes that cover your own finger and start gently brushing their gums twice a day even before they have teeth. Keep up that habit with a regular child-sized toothbrush and a teeny dab of children’s toothpaste once they have a few teeth and a big enough mouth. Flossing should technically begin as soon as the first tooth is in but cut yourself some slack if your baby is closer to 1 before you really get info flossing. I highly recommend the stick flosses that come prepped with about a ½ inch piece of taught floss with a plastic handle. Even with my big kids, I find those to be much easier than wrapping the floss around my fingers and trying to fit in those little mouths.

Second, when to see the dentist? That answer will vary by child depending on their comfort level with strangers and new settings, ability to sit still, etc. It’s better to wait a little and increase the likelihood of a positive first encounter with the dentist than rush it, assuming there are no dental concerns. My kids have all had their first dentist appointment between the ages of 2 and 3. Having older siblings definitely helps to get them prepped so they have a visual of what the appointment will be like before it’s their turn. There are fun apps to help with that as well; we used to have one called Ed The Dentist. Choosing a kid-friendly dentist is very helpful. The kids get to watch cartoons at our dentist’s office, which they love, and there are some toys in the waiting room to keep them content before their appointment.

Third, how do you keep dental hygiene fun? This can be anything from colorful toothbrushes to flavored toothpaste to superheroes flying into their mouth to save their teeth from evil decay (get creative and keep it upbeat). Several years ago, I decided I needed a pneumonic to help the kids remember to brush each section of their teeth every time they brush, and I knew that if I could come up with something fun, they would be more likely to use my technique. Inspiration hit one day with a song loosely to the tune of Row, Row, Row Your Boat. It goes like this:

 

Left, Center, Right and Slide Back

Left, Center, Right and Slide Back

Left, Center, Right and Slide Back

Left, Center, Right and Slide Back

Molars, Molars, Molars, Molars

And Tongue

 

Which loosely correlates with:

 

Row, Row, Row Your Boat

Row, Row, Row Your Boat

Row, Row, Row Your Boat

Row, Row, Row Your Boat

Merrily, Merrily, Merrily, Merrily

Down Stream

 

It’s a bit of a stretch, but try to find a little rhythm as you brush your children’s teeth tonight. The first 4 lines refer to the front side of the lower teeth, back side of the lower teeth, front side of the upper teeth, and back side of the upper teeth, always sliding back across the biting surface of the teeth. The molars line hits all 4 quadrants of molars and should be sung with a fun crescendo, getting louder and more dramatic as you move from the first to fourth molar. You have to sing/hum the song very slowly to have time to brush each tooth along the way. If this rendition isn’t quite working for you, see if you can come up with another fun pneumonic, whether it’s a song or story or a counting game – anything that makes it more fun and easy to be sure your kids are brushing all their teeth.

Fourth, when and how do you guide your children to independence in their dental care? Thank goodness, my kids have yet to have a cavity, but we did have a little scare when my oldest was 7 and the dental hygienist said he had a spot of tartar (a build up of plaque) in the upper-right corner of his mouth. I have since learned that this is a really easy spot for parents to miss when brushing their children’s teeth because it’s a tricky angle for those of us who stand on the right side of their child at the sink, and you really have to get your kids not open their mouths quite so wide to be able to sneak the toothbrush between those teeth and their cheek. But I digress, in this case I was so worried I had let my son down because in the months prior to that check-up, he had started brushing his own teeth much of the time. He had developed a good routine of going potty and brushing his own teeth before bed, and with 3 younger kids to be helping, my husband and I praised him for that and encouraged him to continue. The hygienist shared with me that she brushed her own children’s teeth until they were 12 years old. At first that seemed extremely late, but given the long-term impact of good dental hygiene, we have resumed brushing and flossing all of our children’s teeth each evening; the big kids brush their own teeth in the morning. There are plenty of other domains in which they can grow their independence in the meantime – cooking, laundry, schoolwork, etc.

Remember to Make Your Parenting Fun

At the end of a grocery trip on this rainy morning, I juggled an umbrella and a shopping cart while helping my nearly 3 year-old into the car but did not strap him in because lately he has been interested in doing that part himself. Once the groceries were secured and I had hopped in the car, I checked and saw that he was not yet strapped in so I politely asked him to do so. Apparently today he had lost interest in being independent with a seatbelt. Thinking this through quickly, I decided that I didn’t want to get back out in the rain to help him when he could certainly do that for himself so some problem-solving was needed, and I remembered he is still a wee lad and might need some extra motivation. Fortunately, I had in my hand the open mint case that he had been eating from in the store, so a perfect operant conditioning moment had presented itself.

Positive reinforcement to the rescue! I said to my son, “Oh look, I have your mints and you can have them for the car ride home as soon as you’re strapped in.” This was greeted with a “hmph,” crossed arms, and a frown, so I could see this was going to be a bit of a struggle. I certainly did not want to cave in at this point and teach him that he does not have to strap in when I ask or that he can have mints without strapping in. As you know, consistency is supremely important in parenting and he needs to learn that his behavior has consequences. But at the same time, he is so little and cute, and I did not want to have to strap him in and then hear him crying on the way home about not getting the mints. This is where it becomes important to insert “fun” into your parenting. You can efficiently use operant conditioning while staying happy and keeping your child happy. In this example, I turned our little stand-off into a fun exchange by giving him a wry smile and starting to shake the mints case like a musical instrument while singing a little song, “Strap in to get your mints.” Success! Seatbelt on, mints go to the adorable boy who learned to follow instructions and be independent, and we all drive home happily. There was definitely that moment of suspense when I worried that things would not go so smoothly, but I always try to keep my cool in those little stressful parenting moments, and they usually turn out great, especially if I remember to keep things fun. Being a kid should be fun and being a parent should also, so try to enjoy your parenting this week while still using your helpful parenting tools!

Using Operant Conditioning to Train Your Children to Have Good Manners

Circling back to our discussion on reinforcement and punishment (see Understanding Reinforcement vs. Punishment from 2/8/18), now that you have an understanding of the basics, it’s time to learn more about operant conditioning. As a reminder, below is the chart showing the 2 forms of reinforcement, positive and negative, as well as the 2 forms of punishment, positive and negative. Remember that positive means adding something while negative means removing something, as opposed to positive meaning good and negative meaning bad. If I were B.F. Skinner, I would have chosen less confusing terms.

Positive Negative
Reinforcement Adding something good

Ex: Praise

Removing something bad

Ex: Stropping a nagging song

Punishment Adding something bad

Ex: Cleaning house

Removing something good

Ex: Taking away a toy

Skinner’s original works used pigeons and rats to demonstrate his learning theory. Though your munchkins are infinitely brighter than pigeons and I would never compare them to rats, the same concepts apply, sometimes when I’m thinking about how to motivate my children’s behavior, I like to simplify things by thinking of them as little birds pecking away at a lever in order to earn their food pellet. The term shaping is used in behavioral psychology to describe the process of teaching a subject to perform a certain behavior by reinforcing successive approximations of the desired response, just as you patiently guide your children toward desired behaviors. I would like for all of my children to be polite and thankful. For example, I would like my 2 year-old to ask for milk by saying, “Mom, may I please have a glass of milk” but I can’t expect him to magically start speaking this way when he first develops communication skills. First, he cries to tell me he wants milk. Then he grabs or points. Then he says “milk”, then “milk please”, and so on until one day he learns to say the complete, polite request. Each of those steps was a successive approximation of the desired response and was rewarded along the way, but once he was ready to move on to the next step I had to stop reinforcing the previously rewarded behavior (i.e., when he was able to speak, I waited to give him the milk until he said “milk” rather than when he simply pointed to the refrigerator). Fortunately children have a well developed understanding of spoken language long before they can verbally express their own thoughts, so I could prompt him for the behavior by saying, “Would you like a milk? Say, “Milk please Mom.” Now that he can say complete sentences, I don’t hand him the milk until he makes a polite request. I have shaped that behavior over time. You have likely been through this process with your children for any number of desired behaviors. Remember that you have the power to set the ultimate goal, so if you want your children to be polite, don’t stop at “Mom, can I have a glass of milk?” (or one of my pet peeves, “Mom, I want milk.”). Choose not to reinforce that behavior until “please” is added at the end of the sentence.

The same concept of shaping applies to training your children to say “thank you”. In addition to asking politely for the glass of milk, I would like my children to say “thank you” when I hand it to them. This is a behavior that is learned through your child’s interactions with you and other people in their lives with whom they spend a significant amount of time, so get on the same page with other caregivers. Often young children have the best manners when they are new talkers because it is so rewarding for them to receive positive reinforcement from you when they say in their adorable little voices, “thank you” as you hand them the glass (or sippy cup) of milk with a big smile. Your praise acts as a reinforcer beyond the reinforcer of receiving the milk itself. This process of using reinforcement to pair the act of you handing the child the milk with a loving smile with the desired response of them saying “thank you” is called acquisition. This polite behavior may fade over time as the novelty of your child’s response wears off and you react less and therefore unintentionally withdraw part of the reinforcer (they are still getting the milk but your loving smile is not prominent). This is called extinction because you have extinguished, or removed, the connection between being given the milk and them saying “thank you” by removing the reinforcer.

Shaping is then needed to re-aquire the behavior. Now the reward must not be provided until the desired behavior is exhibited (i.e., you don’t give them the milk until they say “thank you”). The most commonly heard cue from parents trying to teach their children to say “thank you” is “What do you say?” after the child already has the milk in their hands. Taking a lesson from behavioral psychology, you’ll find that the desired response is more quickly learned and more consistently exhibited if you without the reward until after the child says “thank you.” To do this you might say “What do you say?” or “What’s the magic word?” while still holding the milk in your hand, but I prefer more subtle techniques like offering the child the milk but not releasing it until they say “thank you”. Don’t think of this as a tug of war but rather, picture your child’s surprised reaction as they go to the grab the milk and discover that it has not been released (this lesson is best taught with sippy cups or water bottles for spilling concerns). Without saying a word, you offer an expectant look (eyebrows raised with a knowing smile), and it’s as though you can actually see gears turning in their heads as they think through “What on earth is mom doing? What is she waiting for? Oh, I need to say thank you.” This can be such a fun learning moment; I have found that my children and I usually leave these interactions with a big smile on our faces, rather than the child feeling like they’re being nagged, yet again, to have good manners. This brings us full circle to the idea of maximizing reinforcement in your parenting. This is an example of negative reinforcement because I’m stopping something bad (hanging onto the milk) in order to increase the likelihood of a behavior (saying “thank you”). Reinforcement can be so powerful in your parenting and is so much more enjoyable as a parenting technique compared to punishment. See if you can get better manners out of your kids this week by being an operant conditioning pro!

Understanding Reinforcement vs. Punishment

I simply cannot blog another week without covering reinforcement and punishment. These are terms you have probably heard before and you may have a thorough understanding of them or an inkling about what they mean, but they are critical to parenting so let’s spend some time refreshing your memory. The quick psychology history lesson is that these terms are part of B.F. Skinner’s operant conditioning theory that developed in reaction to John B. Watson’s classical conditioning theory (think Pavlov’s dogs) and spawned the behaviorism movement in psychology. We’ll talk more about Pavlov and Watson another time. We now know that both forms of behaviorism are valid in different applications, and from the later cognitive psychology movement we know that thoughts and attitudes clearly cannot be ignored as influences on behavior. For today, let’s focus just on how parents can use reinforcement and punishment to improve their parent-child interactions. To understand these concepts, it is simplest to look at them in a grid:

  Positive Negative
Reinforcement Adding something good

Ex: Praise

Removing something bad

Ex: Stopping a nagging song

Punishment Adding something bad

Ex: Cleaning house

Removing something good

Ex: Taking away a toy

Reinforcement comes in two types, positive and negative. Positive reinforcement means adding a pleasant stimulus (adding something good) to increase the likelihood of a behavior. If your child says, “May I have the milk please,” you hand the milk and say, “Here you go Johnny, and I love how you used your good manners.” Johnny is happy to receive your praise and is more likely to say please in the future. Other examples of positive reinforcement are clapping when a child puts their shoes on by themselves, scheduling a play date when they show good behavior at home, or getting a lollipop at the end of the grocery trip if they sat nicely in the cart.

Negative reinforcement means removing an aversive stimulus (taking away something bad) to increase the likelihood of a behavior. A couple of my kids have gone through phases where they would get in the car and take forever to put on their seatbelts. After trying a few different approaches, I found the one that worked best for my munchkins is singing the seatbelt song, “The first thing you do when you get in the car is strap in, strap in” and simply saying that over and over again (with increasing volume if necessary) until they strap in. If you have a good singing voice, this technique may not work for you, but when I say those first few words of the song, they usually get to buckling up quite quickly now. More examples of negative reinforcement are a child putting away their shoes so mom stops nagging them, letting a child walk on the sidewalk without holding your hand when they agree to stay right next to you, or switching the radio station after a child adds “please” to their request.

Punishment also comes in two types, positive and negative. The term positive can be very confusing in this context but remember positive just means to add something (good or bad). Positive punishment means adding an aversive stimulus (adding something bad) but this time the stimulus is meant to decrease the likelihood of a behavior. For example, if my boys get too rough with each other, they are put to work cleaning the house. First they must “check-in” with the victim. In our house this means a sincere apology in a nice tone of voice and an inquiry as to how the guilty party may help to make it up to the victim (take a turn with a coveted toy, clean up the toys they were playing with, etc.). But if mom has to get involved because the roughness continues, they are off to wipe down the walls, doors, or table chairs. A little physical labor helps to get out that extra energy and deter further roughness. Other examples of positive punishment are speaking to your child in a firm tone, giving a disapproving look when you see your child behaving poorly, or having to say 10 nice things for every unkind thing they say to someone.

Finally, negative punishment means removing a pleasant stimulus (taking away something good) to help decrease the likelihood of a behavior. When one of my boys was 7 years old and regressed into biting siblings when he was angry, we tried a few approaches and ultimately had to step things up a notch by making the rule that if he bit someone, that person could choose any one of his Lego sets to play with for an entire week. This happened once and there were tears, complaints that the punishment was too harsh, and sadness when the Lego set was dismantled by a younger sibling, but we felt that this was a very serious behavior that needed to be stopped. It tugged on my heartstrings to see him so upset, but guess how many times he has bitten a sibling since then…zero! More examples of negative punishment are leaving a play date early for poor behavior, skipping dessert if you don’t eat your dinner, or removing toys if you don’t clean up after playing.

So there you go, four powerful tools in your parenting tool belt to help motivate your child’s behavior to be more in line with your expectations. Amazing parents use reinforcement throughout the day, every day. Punishment should be used infrequently after first attempting other options. Parenting can be very frustrating at times, and even the best parents sometimes loose their cool and yell at their children, but your goal should be to avoid that form of positive punishment. Physical punishment, such as spanking, should never be used. Now that you have a better understanding of these terms, take a look at how you interacted with your children today and see if you can fit examples from your own life into these four categories. If you’re heavy on the punishment side, make it your goal to focus on reinforcement tomorrow!