Checklist for Child Care Staff: Best Practices for Good Oral Health

The tip sheet provides best practices related to foods, drinks, and oral hygiene to promote good oral health for infants (birth to age 1), toddlers (ages 1–3), and young children (ages 3–5). Review information on how to handle basic oral health emergencies.

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Staff play an important role in promoting oral health in child care programs. Staff can check the items below that reflect what they are doing to promote good oral health for babies, toddlers, and young children. Any items not checked can serve as goals to help staff work toward improving their practices related to foods and drinks and oral hygiene.

Babies (Birth to Age 1)

Foods and Drinks

• Hold babies while feeding them breast milk or infant formula from a bottle.
• Never put babies to sleep with bottles or sippy cups. Also, never prop bottles into babies’ mouths.
• When babies are able to eat solid foods, give them healthy foods like fruits, vegetables, milk products (cheese, yogurt), and wholegrain products (bread, cereal) for meals and snacks. Follow U.S. Department of Agriculture Child and Adult Care Food Program requirements for meal and snack preparation, service, and storage.
• Do not serve babies juice.
• Offer babies over age 6 months tap water, ideally with fluoride, throughout the day.

Oral Hygiene

• Make sure that each baby has their own infant-sized, soft-bristled toothbrush. Label the toothbrush with the baby’s name.
• Replace each baby’s toothbrush every 3–4 months, when the bristles become worn or frayed, or after an illness.
• Wash hands with soap and water before and after brushing each baby’s teeth. Child care program staff should wear a new pair of gloves for brushing each baby's teeth.
• Brush babies’ teeth with a small smear (rice-size amount) of fluoride toothpaste as soon as the first tooth comes into the mouth.

Toddlers (Ages 1–3)

Foods and Drinks

• Do not allow toddlers to carry bottles or sippy cups around with them.
• Give toddlers healthy foods like fruits, vegetables, milk and milk products (cheese, yogurt), and whole-grain products (bread, cereal) for meals and snacks. Follow U.S. Department of Agriculture Child and Adult Care Food Program requirements for meal and snack preparation, service, and storage.
• If you serve juice to toddlers, give no more than 4 oz of 100 percent fruit juice per day. Serve juice in a cup, not a bottle or sippy cup.
• Limit foods and drinks with added sugar. If foods and drinks with added sugar are served to toddlers, give them as part of a meal, not as a snack.
• Offer toddlers tap water, ideally with fluoride, throughout the day, and encourage them to drink.

Oral Hygiene

• Make sure that each toddler has their own child-sized, soft-bristled toothbrush. Label the toothbrush with the toddler’s name.
• Replace each toddler’s toothbrush every 3–4 months, when the bristles become worn or frayed, or after an illness.
• Wash hands with soap and water before and after brushing each toddler's teeth. Child care program staff should wear a new pair of gloves for helping each toddler brush their teeth.
• When dispensing toothpaste from a tube, put the toothpaste for each toddler on the rim of a cup or on a piece of wax paper, and scoop the toothpaste from their cup or wax paper onto the toddler’s toothbrush. Or make sure that each toddler has their own labeled tube of fluoride toothpaste.
• Help toddlers brush their teeth with a small smear of fluoride toothpaste.
• After brushing, have toddlers dribble the remaining toothpaste into a cup, but do not have them rinse. Then have toddlers wipe their mouth with a napkin and place the napkin inside the cup. The cups and napkins are thrown away.
• Do not allow toddlers to play with toothbrushes.
• Rinse each toothbrush, and store the toothbrushes in a holder that allows them to air dry (no toothbrush covers) in an upright position without touching each other.
• Disinfect the sink after all the toothbrushes are rinsed and put away.

Young Children (Ages 3–5)

Foods and Drinks

• Give children healthy foods like fruits, vegetables, milk and milk products (cheese, yogurt), and whole-grain products (bread, cereal) for meals and snacks. Follow U.S. Department of Agriculture Child and Adult Care Food Program requirements for meal and snack preparation, service, and storage.
• If you serve juice to young children, give no more than 4 to 6 oz of 100 percent fruit juice per day.
• Limit foods and drinks with added sugar. If foods and drinks with added sugar are served to children, give them as part of a meal, not as a snack.
• Offer children tap water, ideally with fluoride, throughout the day, and encourage them to drink.

Oral Hygiene

• Make sure that each child has their own child-sized, soft-bristled toothbrush. Label the toothbrush with the child’s name.
• Replace each child’s toothbrush every 3–4 months, when the bristles become worn or frayed, or after an illness.
• Wash hands with soap and water before and after brushing each child's teeth. Child care program staff should wear a new pair of gloves for helping each child brush their teeth.
• When dispensing toothpaste from a tube, put a pea-size amount of toothpaste for each child on the rim of a cup or on a clean piece of wax paper, and have the children scoop the toothpaste from their cup or wax paper onto their toothbrush. Or make sure that each child has their own labeled tube of fluoride toothpaste.
• Help children brush their teeth with a pea-size amount of fluoride toothpaste.
• After brushing, have children spit the remaining toothpaste into a cup, but do not have them rinse. Then have children wipe their mouth with a napkin and place the napkin inside the cup. The cups and napkins are thrown away. 
• Do not allow children to play with toothbrushes.
• Rinse each toothbrush, and store the toothbrushes in a holder that allows them to air dry (no toothbrush covers) in an upright position without touching each other.
• Disinfect the sink after all the toothbrushes are rinsed and put away. 
• Promote good oral health by regularly including oral health topics in the curriculum such as:
  • Eating healthy foods
  • Brushing teeth with fluoride toothpaste
  • Visiting a dental office or clinic
  • Preventing oral injury, for example, by wearing a helmet when riding a tricycle or scooter

Oral Health Emergencies

• Have a plan and a first aid kit to handle oral health emergencies such as:
  • Toothaches
  • Cut or bitten tongue, lip, or cheek
  • Broken tooth, broken jaw
  • Continued bleeding after a primary (baby) tooth falls out
• Have a plan for transporting a child with an oral health emergency to the child’s dentist or the nearest source of emergency oral health care.
• Have contact information for each child’s dentist and a signed release form that allows the child’s dentist to share information with the child’s child care provider.

Last Updated: August 30, 2024