First doctor visits most important, set a tone

By Wendy Giroux
Reporter Newspapers

In the whirlwind of medical care that heralds the beginning of a child’s life, it is easy for some important health checkups to get overlooked, local doctors and dentists say.

Parents are often busy just trying to keep up with vaccinations and child visits to the pediatrician. But health officials say that parents need to take every young child for early visits to the dentist and optometrist.

Statistics show that tooth decay is the most common chronic childhood disease, and that about 10 percent of children will have some sort of vision problem.

Both dentists and optometrists say that catching any signs early is the key to treating any problems and helping each child to be as healthy as possible.

“First and foremost, most dental diseases are preventable,” said Dr. Joel Berg, University of Washington professor and chair of the Department of Pediatric Dentistry and School of Dentistry. Berg is also a spokesman for the American Association of Pediatric Dentistry.

“In all of dentistry, there’s nothing more important than the age 1 dental visit. It sets you off for a life of health,” Berg said. “If you can establish a positive cycle, children can go their whole life and be cavity free, and that all starts at age 1.”

Eastside Pediatric Dentistry’s Dr. John Liu agreed, noting that it is best to meet a new dentist for the first time when there is nothing wrong and the parents can decide whether that dentist is a good fit for their family. That way, if the child ever has a dental emergency, the parents will have someone to call.

“Panic situations will go a lot easier with a previously established dental home,” Liu said.

He also recommends that parents start even before teeth come in, by cleaning their child’s mouth and gums with a clean washcloth after feedings so that the child gets used to the idea of cleaning after eating.

“A clean mouth for the teeth to come into is going to go a long way” toward helping establish a healthy mouth, he said.

By the time a child turns one, typically only a few teeth have come in, and it is a good time for dentists to look at any potential risk factors, Berg said. They also usually talk with parents about three important issues that affect dental health: diet, hygiene and fluoride.

When thinking about what your child eats, dentists say it is important to think about how often they eat, what they eat and how long the food sits on their teeth afterward. It is always important to brush, but parents should be particularly vigilant after sweet, sticky foods and drinks (note: this doesn’t mean just candy, but also “healthy” snacks such as dried fruits and raisins).

When brushing the teeth of a young child, Berg and Liu both emphasized the need to not only position the child so that you can see what you are doing (and even have someone help you restrain the child’s arms if necessary), but to also position the brush so that the bristles are getting to the areas that need attention.

“We know it’s not easy. A 1-year-old is usually going to protest,” Liu said.

When talking with parents, Liu said he always emphasizes the two “P’s”: patience and persistence.

“Look at each surface of each tooth,” Berg recommended. “It’s something that has to be done every day.”

Don’t assume that your child will be able to brush alone anytime soon, he said.

“Kids don’t have the dexterity to brush or floss themselves until age 8 or later. … No matter what parents think, the dexterity is not there,” Berg said.

Also, during the first visit, it is a good idea to discuss the child’s “total fluoride picture.” That includes whether the water coming out of the tap has fluoride — and how much it has — as well as looking at whether the child uses a fluoride toothpaste. The dentist will determine whether children need additional treatments when they come in for office visits.

Liu stressed that parents should call the agency that their water bill comes from and ask whether there is fluoride in the tap water. A small amount of fluoride was detected in the water supplied to Mercer Island in a 2005 quality report.

The most common issues that dentists see in young patients are plaque on the teeth from inadequate brushing and/or flossing (and the cavities and discoloration that come from consistently having plaque on the teeth), inadequate fluoride, and children who still use a bottle at bedtime, Berg said. Children who were premature or of low birth weight are much more likely to have tooth defects, as well as children who take frequent medications. That is because medications can dry out the mouth or have a high sugar content, neither of which are good for the teeth.

Programs at the county, state and national level are aimed at increasing parent awareness about getting children to the doctor, dentist and optometrist at an early age — and then continuing to visit regularly.

Establishing a health-care ‘home’

“Our program tries to get all the kids in the county health insurance and then establish a health-care ‘home,’ for each child,” said Lisa Podell, program manager for Children’s Health Initiative with Public Health, Seattle & King County.

The Children’s Health Initiative has health educators who are out in the community working with parents to make sure they understand the importance of taking infants and toddlers to the dentist. Program educators also work with doctors at clinics throughout the county to help ensure they are addressing these kinds of issues.

“There’s a big checklist that the American Academy of Pediatrics recommends be done in each 10- or 15-minute well-child check [appointment],” Podell said, noting that it’s a big load on the shoulders of pediatricians.

Many people who are eligible for help with health insurance do not even know they can apply, she said, so program workers visit schools, food banks, community centers and other locations to connect with parents and let them know.

“You can make over $50,000 for a family of four and still be eligible,” Podell said. Unfortunately the application is a bit cumbersome, so her staff members also help people through the process.

Addressing the health-care “home” again, Podell said that some parents and children miss out on developmental screenings if they are always running from specialist to specialist. So it is vital for each child and parent to stay in close contact with one doctor and have a trusted relationship with that person.

“If there are specialists needed or other services, they coordinate that,” she said. “If you don’t have a ‘main’ doctor, then [your child] may not get any developmental screening.”

Those screenings, even if they are simply based on a series of questions asked of the parents, are vital because they can bring to light health issues such as autism, Attention Deficit Hyperactivity Disorder, anxiety disorders and more, Podell said.

Children need eye exams

Vision disorders are the fourth most common disability in the United States, as well as the most prevalent handicapping condition during childhood, according to the InfantSEE program, a national public health partnership between the American Optometric Association and Johnson & Johnson.

“The stand right at this point and time is to do a vision assessment at six months, and then at [ages] 2 and 4,” said Dr. Kerry Moscovitz, who owns New Vision Eyecare practices in Sammamish and Mercer Island.

Along with optometrists like Moscovitz and his associate, Dr. Heidi Sutter, InfantSEE is working to increase awareness of early vision checks.

For those children who do have some kind of issue, treatment can hugely improve their lifelong vision.

The two most common problems young children are diagnosed with are strabismus — a type of eye turn that can cause lazy eye — and the need for glasses, sometimes to prevent lazy eye, Moscovitz said.

“If their vision doesn’t develop normally in the first five years of life, it could be a real detriment later in life,” he said.

Less common diagnoses include cataracts, which can be removed for better vision, and cancer of the eye, which usually develops in utero and can be removed to keep it from metastasizing to the rest of the body.

Moscovitz said programs like InfantSEE will be key in helping increase awareness of the need for early eye checks.

“I don’t think it’s a good idea to put the blame on parents,” he said, noting that members of the medical field and government agencies should do more public education.

But, like King County’s Podell, Moscovitz said pediatricians likely could use assistance and reminders to check vision more thoroughly during regular checkups. To that end, he and Sutter developed a vision checklist that they distributed to area pediatricians to help coordinate care.

“The importance of trying to get [each child] in earlier is: about 10 percent of children will have some sort of vision issue,” Moscovitz said, noting that not all of those problems are serious. “As parents, we sometimes think these things will go away.

“However, the earlier that you treat them, the better the outcome,” he said. “And, usually, the shorter the treatment.”