429. Q&A: How can I get my toddler to brush their teeth without a power struggle?

Dr. Sarah Bren (00:02):

Ever wonder what psychologists moms talk about when we get together, whether we’re consulting one another about a challenging case or one of our own kids, or just leaning on each other when parenting feels hard, because trust me, even when we do this for a living, it’s still hard. Joining me each week in these special Thursday shows are two of my closest friends, both moms, both psychologists, they’re the people I call when I need a sounding board. These are our unfiltered answers to your parenting questions. We’re letting you in on the conversations the three of us usually have behind closed doors. This is Securely Attached: Beyond the Sessions.

(00:41):

Hello. Welcome back to the Beyond the Sessions segment of the Securely Attached Podcast. Dr. Emily Upshur and I are going to be answering a listener question today. Hi, Emily. How you doing?

Dr. Emily Upshur (00:54):

Hey. Good to be here.

Dr. Sarah Bren (00:56):

So good to see you.

Dr. Emily Upshur (00:57):

Yeah.

Dr. Sarah Bren (01:00):

I’m really excited about this question because I feel like I have some, what’s it called? Solidarity to share with us.

Dr. Emily Upshur (01:07):

I was going to say PTSD.

Dr. Sarah Bren (01:09):

Right? I don’t know if this is a question about toothbrushing and my kids are notoriously like… It’s so hard in my family for some reason about this. So would you care to hear the question?

Dr. Emily Upshur (01:22):

Let’s do it.

Dr. Sarah Bren (01:23):

All right. So this mom wrote in, she said, “Hi, I’ve been struggling to brush my three year old’s teeth. How do I get her to cooperate with me? I have succeeded in brushing most of her teeth a couple times and I’ve managed to brush just her front teeth many times. But most of the time when I try, she cries and covers her mouth with her hands and runs away. If we use even a tiny amount of toothpaste and a flavor she likes, she’ll just suck on the toothbrush and ask for more. Once she let me brush her teeth when I said we would have pizza for lunch, but that sort of thing isn’t a sustainable solution. Sometimes she wants to brush teeth by herself rather than let me do it, but that’s more like pretending to brush teeth. We have powdered tooth powder and once I recently used a tiny bit of unflavored tooth powder and I brushed the front of her front teeth, but she reacted like she didn’t like it.

(02:08):

I also have a bubble gum flavored tooth powder I haven’t been able to try using with her yet. I bought the unflavored one because of the fact that she’ll likely want to eat it if she likes the flavor and I’m trying to avoid that. I wish I had introduced toothbrushing when she was between one and two before she started trying to exert her free will, but I didn’t think she needed to yet back then because I still considered her a baby. Thanks. Oh my God. I can feel this mom’s anxiety and I can so seriously relate to it, but I think the thing that jumped out at me when I read this question the most that I wanted to be explicit about is that I feel like this mom’s kind of beating herself up over having missed a window or feeling like the reason why this is hard is somehow on her. And I just want to like kind of name that and say this might be something that’s hard for your kid and you might have to kind of throw a lot of spaghetti at the wall to see what sticks before you figure it out and that that’s okay.

Dr. Emily Upshur (03:10):

I was like, “Wow, I’m so impressed you’re trying to brush your three year old’s teeth. This is amazing.” But when you got to the bottom of the question when she was like, “I regret not having started sooner,” I’m like, “Congratulations, you’re doing a great job. This is really good.”

Dr. Sarah Bren (03:25):

Yeah. And listen, I think that to the mom who wrote this in, you have had so many, like you’re iterating. And I actually think iteration is an unvalued step in the parenting process that we sometimes maybe make people think it’s not part of it or we skip over it when we’re talking about doing a strategy or something. But there’s like a million strategies. I don’t know if you’ve ever been on Instagram lately, but you’ll probably notice there’s a million strategies for the same thing. And the reason why I think is because different strategies work for different kids and some work really well for some kids and don’t work for others and you kind of have to play around with it. I also think because this she sort of described like she didn’t introduce this early and that’s one, not a problem, solvable. But two, I think we have to kind of, instead of beating ourselves up right now having started early and then being kind of frustrated that it’s hard now, I think we have to put all that into the story.

(04:33):

We started later on when our child had moved into a developmental stage where autonomy and independence and like the I do it and don’t put things in my mouth without me giving you permission kind of thing is it’s really strong right now. So it makes sense that introducing toothbrushing at three, if you haven’t kind of phased it in earlier, you’re going to be met with some power struggles and resistance. And so that actually, instead of it being a frustrating, bewildering barrier, it can actually perhaps just make sense and we could accept that as part of what the task is now. But also because the child doesn’t have a framework for this, we might be thinking, oh well at three you should be able to do X, Y, Z.

(05:25):

But we didn’t introduce baby steps at one, two. So why don’t we go back and sort of think of this as like, if you were introducing this to a one year old, what would you start with? It probably wouldn’t be with the goal of, I want to brush your entire mouth and get… And the goal is to have pristine teeth. It’s just, I want to expose you to the sensory components of toothbrushing. I want to expose you maybe through play to the materials that we use. I want to create kind of a chill, relaxed environment around toothbrushing and toothbrush exploration because that’s what you’d probably do at one. We don’t skip those steps just because we’re starting later. And I think that’s perhaps the kind of core, I don’t want to say mistake, but that was like kind of the user error that happened here because you think, oh, I’m starting at three, so I start where the three year old brushes.

(06:21):

But we actually have to start where the one year old would learn toothbrushing skills, not because your kids developmentally a one year old, but because you have to start at the beginning no matter what age you start at.

Dr. Emily Upshur (06:34):

Well, and I think you’re like sort of subtly also saying like it’s okay to kind of lower your expectations of the fidelity of the teeth brushing. The kind of subtle thing you’re saying is, I don’t know if you brush the front of her teeth and we don’t make it a power struggle and we use levity and play. Maybe we’re winning. I think that instead of thinking that as like, oh, I haven’t successfully brushed all her teeth, thinking of it as, okay, so we’re succeeding at this introduction. We’re doing really well. We’re making this like a not torturous experience. Here we are. Even if we only brush the… It’s more about the process and the outcome.

Dr. Sarah Bren (07:16):

Yes.

Dr. Emily Upshur (07:16):

And I think that’s sort of the thing you’re sort of touching on with that.

Dr. Sarah Bren (07:20):

Yes. The process, but also breaking down kind of the whole, what will eventually be the whole complete task into small little bits and pieces and working on just exposure first, not mastery. So can we experiment and sort of think of it like an exposure to the sensory experience of toothpaste or having a brush in our mouth? She was saying sometimes she wants to brush her teeth by herself rather than let me do it, but because that feels like it’s pretend toothbrushing and not my teeth are clean, that that was maybe perhaps deemed not the right path. But I actually think if you have a toddler who wants to brush them teeth themselves and you are also struggling with power struggles around toothbrushing, let’s go with that. Let’s lean into that. Even if it means the teeth are not going to be optimally clean when they’re done with it because right now we’re just trying to have basically build this child’s relationship with toothbrushing, not clean the teeth. And I know if you’re a dentist listening, you might be cringing, but like –

Dr. Emily Upshur (08:37):

Earmuffs.

Dr. Sarah Bren (08:38):

I’m a therapist, not a dentist. And I genuinely believe that the long term relationship with doing this process and tolerating the discomfort or the intrusiveness of it, it’s hard for some kids.

Dr. Emily Upshur (08:57):

Or even just the command nature. I’m asking you to do something at a time which is tricky. Bedtime can be tricky at a tricky time in family life.

Dr. Sarah Bren (09:09):

That’s another good thing. I’m asking you to do a demand. You just gave me another, you made me remember another thing, which is sometimes switching up the time. Yes, there’s a reason why people brush their teeth in the morning and at night before they go to bed, but you don’t have to follow those rules either if we’re working on exposure.

Dr. Emily Upshur (09:26):

Oh my gosh, you just made me remember my kids’ daycare used to brush teeth at lunch. I totally forgot about that. Yeah, because it took it out of this power struggle, also out of the hardness of the nighttime routine.

Dr. Sarah Bren (09:38):

Yeah. Oh my God. If you outsource this, mama. Oh my gosh. If your kid is a daycare, if your three year old is enrolled in a daycare, send a toothbrush and some bubble gum tooth powder or whatever you want to use and put it in their lunchbox and ask the daycare team. Again, remember, process, not outcome. The goal isn’t for them to brush your kid’s teeth at school. It is for the exposure. It’s to say after they’re done with their meal, can you please give this to them to spend a little bit of time sort of playing with? Could they do a little toothbrushing time? Again, being clear to the daycare instructor that you do not have to have this kid’s teeth. We don’t need to create a new layer of power struggle either. We just want to set expectations for the care providers too.

(10:30):

And if you don’t have a care provider and the kid’s not a daycare and you’re with them all the time, then you can try it at lunchtime too. It doesn’t matter who does this, but I love that idea. But if they are going to daycare, sometimes it’s just like practicing something in a different environment with different people that you have a different relationship with can be just the response is just different. It’s like a different chemistry happens.

Dr. Emily Upshur (10:53):

Well, I also think truthfully, it is less of a command demand at the end of a day. We all know that that’s a really hard time too. So it’s a different setting, different framework environment, but also really mindful of the time of day. And I also love the idea of it actually doesn’t matter. Dentists, earmuffs again, but to me it’s like you can brush your teeth at 3:00 PM. If they’re interested in brushing their teeth at 3:0 PM, let them brush their teeth at 3:00 PM. I think we get a little rigid around, again, I’m back to the process, not the outcome. And I think if we can really nail that process and break it down to your point into these steps that might be exposures, then I think we have a better chance of directing it when we want it. Okay, let’s do it right before bed. But I think we’re like 10 steps before that before we sort of introduce that sometimes.

Dr. Sarah Bren (11:51):

Yeah. And I’m looking at this question again and I want to tie in a few more things that this person is asking about because I think it’s kind of important to say like, okay, you’ve been having power struggles. So how do you reset if you’re going to try something different? Because I know it’s like, “Oh, these are cool ideas. Maybe I’ll give them a shot.” But it doesn’t always land if the cues are still present for this to be kind of yuck. And we just try to put in some new strategies. We might not ever get to the place where we get to practice the strategies because our kid’s going to run away because they’ve already associated this time with something not fun. So I would really reset explicitly with your kid. I would say, “You know what? This has been such a tricky time.

(12:38):

We’ve not been having a good go at this. I think we need to take a little minute to just take a break and reset.” And you could be goofy, you could be playful, you could shake it out, be funny. But you could really say like, “We’re going to do something different starting tomorrow.” Or if you say this maybe at the morning time, you could say, “We’re going to do something different starting tonight.” But you can say –

Dr. Emily Upshur (13:06):

Yeah. Sorry.

Dr. Sarah Bren (13:07):

Tell me what you were going to say.

Dr. Emily Upshur (13:08):

What I love is also I love the idea of changing up the sort of routinized piece of it to your point with the associations. I love the simplest and they might seem like frivolous, but I’m like, new toothbrush. New bathroom, different bathroom. Resetting the environmental cues that are automatically associated in your routines and in your bodies and being a little playful with it is the other thing I’m hearing from you.

Dr. Sarah Bren (13:39):

So I might even, especially if this is really quite challenging and the kid is having a really strong reaction, like she’s crying and covering her mouth and running away. I might set the setting actually in a place where it’s playful. So I might say like, “So we’re going to do something different. We’re just going to practice using these tools and we’re just going to make it fun. And the goal is really to just get comfortable with this. So maybe that looks like in the kitchen. We’re going to put on some music and have a toothbrush dance party. Or yeah, we have a new toothbrush, whatever. But maybe you’re going to brush my teeth and then you can brush your teeth. If you want, I could brush your teeth. But really it’s just about dancing to the music with our toothbrushes. And it’s like one song and it’s our toothbrush song.

(14:38):

And it’s really about making these associations more fun, more playful, less pressure, less demand. Again, the demand I think probably is a big piece that our kids might be reacting to. There’s something very vulnerable about having, even if you’re in such a safe relationship with your parent, having a foreign object, a hard pointy foreign object put in your mouth, it’s very vulnerable. It really is. It’s sensorially very stimulating and it’s just very powerless inducing that sensation of feeling very kind of I’m just being intruded upon in a way that’s not comfortable. So I think for me, that would be the first barrier I would try to desensitize my kid to. I would just really make the toothbrush itself feel less threatening and allow them to put the toothbrush in my mouth, but for them to be the director of the toothbrush.

Dr. Emily Upshur (15:36):

Well, you’re bringing up something really important, which I use all the time. And obviously we do this in our practice, but play. I love brushing doll’s teeth. I like brushing stuffy’s teeth. I like having, again, that mastery and I’m in control feeling for a child to be able to do that. I think that can be really helpful as well. Really play with this and integrate that into a less intense, this is a parenting struggle. Okay, we’re going to give a little levity. We’re going to dance party. We’re going to brush your stuffy’s teeth. All of the things. And I think that sort of helps it alleviate a little bit of the heaviness.

Dr. Sarah Bren (16:19):

I’ve seen puppets be very helpful for things like this. It sounds so funny, but again, because the hand is a little threatening, this feeling of like, okay, here’s this hand with a toothbrush and it coming at me. If a puppet is holding the toothbrush, it’s not as scary. It just feels a little bit more… I don’t know. Again, I’m sort of solving for a very specific issue and I don’t know if that’s this kid’s issue, but again, we’re throwing spaghetti at the wall to see what sticks. If it is about the intimidating element of having this thing coming at your mouth, how do we soften that? How do we make it a little less threatening, a little more playful, a little caricatured?

Dr. Emily Upshur (17:04):

The other thing is they have no idea why we’re doing this. They’re like, “Why do you want to stick this thing with flavors into my mouth?” They don’t have any context for the utility of brushing teeth or why you would brush your teeth. So I think that’s also, we’ve just decided arbitrarily that this is something you can do. So sometimes if you contextualizing it as a part of your bath routine or something, you have to sort of introduce the concept with buy-in.

Dr. Sarah Bren (17:31):

Yeah. That was another thing that helped so much for me because I was saying at the beginning, I’ve really had to get creative with toothbrushing, but I had found now my kids are a little older. It’s a different issue of struggle, but now it’s more just like, don’t tell me what to do. A lot of it was like I needed them to be a captive audience to get them to do it. So we did a lot of toothbrushing in the bath. The bath time was toothbrush time. And that just was a lot easier because I didn’t have to chase them. They held the toothbrush. Again, I was not trying to be like, these teeth are going to pass inspection. I just needed them to put the toothbrush in their mouth for a few seconds and scrub. And they would just do it in the bathtub. And it was like, because I would literally, if you had been a fly on the wall of my house, I was running around the house.

Dr. Emily Upshur (18:23):

I had no idea of your toothbrushing things. Oh my gosh. Oh yeah.

Dr. Sarah Bren (18:29):

Oh, another one I think I made when reels first started on Instagram and I had no idea what I was doing. I did make an Instagram reel about this.

Dr. Emily Upshur (18:37):

Oh my God.

Dr. Sarah Bren (18:38):

Because it was actually really helpful for the age of my kids, which was, what did I say? I was like, “Oh, roar like a lion.” And then they would roar. So they’d open their mouth really wide and I’d get their back teeth. And then I’d say like a snake. So they had to show me their front teeth and they’d go like… And then I’d get their front teeth and then I’d say, “Pant like a doggie.” And then they would go and stick their tongue out and I would brush their tongue. And that was it.

Dr. Emily Upshur (19:09):

You tried really hard. I’m going to say hats off to people.

Dr. Sarah Bren (19:11):

Out of necessity. That’s what I’m saying. We are going to have something that our kids don’t want to do and we have to get real creative. The toothbrushing was…

Dr. Emily Upshur (19:22):

That was your jam. Yeah. I’m sorry. And congratulations.

Dr. Sarah Bren (19:26):

But yeah. So try the roar like a lions like a snake and paint like a doggy. Again, full disclosure, when I did that, it took all of 10 seconds and their teeth were not going to pass muster. But because again, I was like, my goal here is exposure. My goal here is play and practice and getting them used to participating in this action, not about crystal clean teeth at the end of it, because eventually we would get there.

Dr. Emily Upshur (19:57):

Well, and I’m going to say if you don’t have as much bandwidth as Dr. Brenn and you aren’t as creative, you don’t have to do that either because that’s a lot.

Dr. Sarah Bren (20:08):

Well, you can just steal my ideas, you don’t have to…

Dr. Emily Upshur (20:12):

But maybe even just brushing your own teeth at the same time as your child brushing their teeth is a motivator. It’s hard at the end of the day, people.

Dr. Sarah Bren (20:22):

It is.

Dr. Emily Upshur (20:23):

I give you grace out there. Do what you can.

Dr. Sarah Bren (20:26):

Do what you can. God speed. I will say one last thing is too, try a variety of different types of toothbrushes. So the other thing that could be if it’s not a power struggle, it could be a sensory thing. And so that is another thing to just experiment with is getting… I tried switching from regular toothbrushes to the electric toothbrushes that vibrated and that actually got them the novelty of that got them to brush a little bit more. And then there’s this brush called like an Autobrush that I’ve tried and that was really, my kids actually really like that now because it’s kind of cool. It was actually, I think it’s like ADA approved because it just has a very different, it’s just totally different than a normal toothbrush. It looks like kind of like a hockey mouth guard that’s attached to like a little battery and it has bristles inside of it.

(21:22):

And you put that in your mouth, like a bite bar or whatever. And it does a little dance and you brush your teeth with it and it’s softer. Well, because I think it was originally developed for people with disabilities who had a harder time brushing their teeth or who had very significant sensory sensitivities. And so it’s ADA approved and it’s, I don’t know. They also have a kids line. So I tried the kids one and it’s cool.

(21:56):

I think my daughter has a unicorn one and my son has a lion one, but it’s cool. Again, throw spaghetti at the wall, see what sticks. Be willing to try to figure out what the core issue is. Is it about power? Is it about discomfort? Is it about vulnerability and needing to practice and play around that? Is it about sensory sensitivity? It’s too much. I don’t like the feeling or I got to get used to the feeling. And so then you could play with like toothbrush, types of toothpaste.

Dr. Emily Upshur (22:27):

Timers.

Dr. Sarah Bren (22:27):

Timers. But above all else, one, be patient, focus on breaking it down in very small steps and slowly building your way up through them. Make it as playful as you can. Low stakes, low pressure. These are baby teeth.

Dr. Emily Upshur (22:46):

These are baby teeth. You’ll get big ones. You’ll get new ones.

Dr. Sarah Bren (22:49):

Yep. And you got this. You got this. I love it. All right. Thanks so much.

Dr. Emily Upshur (22:58):

Yeah.

Dr. Sarah Bren (22:59):

See you again next week.

Dr. Emily Upshur (23:00):

Bye.

Dr. Sarah Bren (23:02):

Thank you so much for listening. As you can hear, parenting is not one size fits all. It’s nuanced and it’s complicated. So I really hope that this series where we’re answering your questions really helps you to cut through some of the noise and find out what works best for you and your unique child. If you have a burning parenting question, something you’re struggling to navigate or a topic you really want us to shed light on or share research about, we want to know, go to drsarahbren.com/question to send in anything that you want, Rebecca, Emily, and me to answer in Securely Attached: Beyond the Sessions. That’s drsarahbren.com/question. And check back for a brand new securely attached next Tuesday. And until then, don’t be a stranger.