1. CHILD FEEDING PRACTICES OF HEAD START PARENTS AND SAFEGUARDING THE ORAL HEALTH OF VERY YOUNG CHILDREN Elizabeth T. Powers Institute of Government & Public Affairs, Department of Economics The University of Illinois at Urbana-Champaign This presentation reflects the views of the author alone.

2. Oral Health of Very Young Children Why is good early oral health important? Oral health influences behavior, speech, and language Poor oral health causes missed school days Early-life poor oral health may cascade into poor overall life-long health What causes early problems? Underlying disease Oral hygiene practices (wiping, brushing, flossing) Feeding practices and diet Elizabeth T. Powers, University of Illinois at Urbana-Champaign 2

3. Dental Care and Head Start Concern for oral health is completely consistent with the Head Start philosophy Children must be healthy in order to be ready to learn Parent involvement is key to all aspects of child development Head Start program performance standards require Assisting parents in obtaining oral health examinations and care for their child. Tracking the provision of oral health care. Recording examination results Developing plans for follow-up care Elizabeth T. Powers, University of Illinois at Urbana-Champaign 3

4. SmileHealthy & the Champaign County Regional Planning Commission's Head Start Oral health care access can be iffy for Head Start children Dentists may not accept Medicaid patients SmileHealthy (SH) provides dental care to all the children in Head Start in Champaign County. Elizabeth T. Powers, University of Illinois at Urbana-Champaign 4

5. About SmileHealthy Mobile dental clinic program Brings care to convenient locations (schools, malls…) Child dental access program Serves children though age 18 residing inside Champaign County, but outside Champaign and Urbana, in families at or below 200% the Federal Poverty Level (about $46,000 for a family of four). Elizabeth T. Powers, University of Illinois at Urbana-Champaign 5

6. SmileHealthy & Head Start Head Start Dental Clinic The Head Start Dental Clinic provides comprehensive dental care to every child enrolled in the Champaign County Regional Planning Commission’s Head Start. (Care is also available for the family members of an enrolled child.) A dentist, hygienist, and dental assistant provide care out of the clinic facility in the community of Rantoul (about 30-45 minutes’ drive from C-U). Dental health education For Head Start and pre-school programs, SH provides age- appropriate monthly lesson plans with classroom activities, teacher instructions, take-home materials and suggested readings for each lesson. Elizabeth T. Powers, University of Illinois at Urbana-Champaign 6

7. Parent feeding practices: Use of bottles & sippy cups… SmileHealthy dentists identified parent feeding practices as the overwhelming cause of (baby) tooth decay in their Head Start patients. Parents should not expose teeth to sugars for long periods, but this is exactly what poor sippy cup and bottle-feeding practices promote. If bottle/sippy cup use is the cause, then early childhood tooth decay is (almost) entirely preventable. SH responded with an additional oral health education program In January 2010, SH started a Head Start parent education program on bottle & sippy cup practices, including face-to-face contact with parents at pick-up and drop-off times. Elizabeth T. Powers, University of Illinois at Urbana-Champaign 7

8. Feeding practices of Head Start and other lower-resource parents In order to better understand the sources of tooth decay, SmileHealthy surveyed parents on their feeding practices. Use of bottles & sippy cups Frequency & timing of use Foods & liquids administered with bottles & sippy cups Ages at which bottle and sippy cup use ended Data A baseline, pilot survey was administered in 2009, prior to the introduction of the Head Start parent education intervention. Surveys were obtained for about 60 children. A revised survey was administered from 2010-present. Information on approximately 350 additional children. Elizabeth T. Powers, University of Illinois at Urbana-Champaign 8

9. Survey responses for children aged 0-5 Elizabeth T. Powers, University of Illinois at Urbana-Champaign 9

10. When a cup or bottle is offered Elizabeth T. Powers, University of Illinois at Urbana-Champaign 10

11. What is offered in a cup or bottle? Elizabeth T. Powers, University of Illinois at Urbana-Champaign 11

12. Frequency of bottle or cup use Elizabeth T. Powers, University of Illinois at Urbana-Champaign 12

13. Age did/plan to stop using a cup Elizabeth T. Powers, University of Illinois at Urbana-Champaign 13

14. Age did/plan to stop using a bottle Elizabeth T. Powers, University of Illinois at Urbana-Champaign 14

15. Multivariate regression analysis Control for background factors: Child age, a ‘young’ parent is respondent, ‘grandma’ is respondent. Control for Head Start history: Head Start participation at interview or in the past Control for SmileHealthy education program: A child is Head Start-enrolled since January 2010 Elizabeth T. Powers, University of Illinois at Urbana-Champaign 15

16. Significant differences in feeding practices Head Start parents are 20% more likely* to use a cup or bottle at meals. Head Start parents are 110% more likely* to use a cup or bottle to pacify a child. Head Start parents are 35% more likely* to feed juice with a cup or bottle. Head Start parents provide 16% more feedings* from a cup or bottle per day. Head Start parents are 84% more likely* to stop bottle feeding at younger ages (by 18 months). *than the sample average Elizabeth T. Powers, University of Illinois at Urbana-Champaign 16

17. Evidence on the SmileHealthy education program Parents potentially exposed to the HS parent education program were 33% more likely* to use a sippy cup or bottle at meals (above ‘base’ effect of 20% for HS in general). Parents potentially exposed to the HS parent education program were 92% more likely* to stop feeding from a bottle by the age of 18 months (above ‘base’ effect of 84% for HS in general). *than the sample average Elizabeth T. Powers, University of Illinois at Urbana-Champaign 17

18. Conclusions from the Multivariate Analysis Head Start parents are much more likely to stop bottle feeding by 18 months! Head Start parents are intense users of bottles and cups.  Head Start parents often feed juice.  Elizabeth T. Powers, University of Illinois at Urbana-Champaign 18

19. Conclusions from the Multivariate Analysis Intensity and juice use…Are these practices ‘bad’? Using a cup or bottle at meals could reflect a more organized home life (i.e., there are times that are thought of as ‘meal times’ with young children). Acting to pacify a child might indicate emotionally responsive parenting. Frequent feeding might indicate more parent-child togetherness. Access to juice could reflect greater nutritional resources available to these parents. Elizabeth T. Powers, University of Illinois at Urbana-Champaign 19

20. Next Steps Linking dental outcomes to feeding practices. Currently obtaining dental records. Test hypothesis that feeding practices matter for outcomes (fillings). Identify practices/clusters of feeding practices that are associated with worse outcomes (more cavities). The behavior of Head Start parents compared to what? This is not a representative sample. It is a classic ‘convenience’ sample. What do we know about feeding practices in households where children have more resources? Elizabeth T. Powers, University of Illinois at Urbana-Champaign 20

21. Conclusions The oral health of very young children importantly affects their ability to benefit fully from Head Start. Head Start practitioners, interacting daily with parents and children, are uniquely situated to provide information to parents about best feeding practices for oral health. Avoid prolonged exposure of the teeth to sugars. Elizabeth T. Powers, University of Illinois at Urbana-Champaign 21

22. Big thanks to… Nancy Greenwalt, Executive Director of SmileHealthy Mallory Baker, SmileHealthy intern Jenny Chan, UIUC independent study student Elizabeth T. Powers, University of Illinois at Urbana-Champaign 22

23. Age distribution (non-HS, HS) Elizabeth T. Powers, University of Illinois at Urbana-Champaign 23

24. Age did/plan to stop using a cup Elizabeth T. Powers, University of Illinois at Urbana-Champaign 24

25. Age did/plan to stop using a bottle Elizabeth T. Powers, University of Illinois at Urbana-Champaign 25

26. Conclusions The oral health of very young children importantly affects their ability to benefit fully from Head Start. Head Start practitioners, interacting daily with parents and children, are uniquely situated to provide information to parents about best feeding practices for oral health. Avoid prolonged exposure of the teeth to sugars. Explore children’s oral health as an indicator and predictor of developmental progress. In particular, very young children identified as having tooth decay may be at greater risk for learning problems, now and later in life, and may need additional investments. Elizabeth T. Powers, University of Illinois at Urbana-Champaign 26