How parents can manage their children with autism

After learning that your child has autism, you'll find yourself filling a variety of roles. At the same time, you'll get a lot of information from different sources, which can make you feel confused and frustrated. As parents, we often have to play more than one role, such as teacher, therapist, activity planner, and so on. 

However, the most important role to play at this time is that of your child’s advocate. Being your child’s advocate will be a life-long journey that will require different skills depending on your child’s needs. It is best to contact a good early intervention centre that can guide you and provide you with strategies for helping your child. A good intervention provider will communicate with you openly and will have a team of experts to help you along the way. Here are some helpful tips for dealing with autistic children.

Reinforce positivity

Children with autism, like everyone else, respond well to positive reinforcement. Reinforcing good behaviour or achieving goals, no matter how big or small, will motivate and encourage them. However, you must be specific when providing reinforcement so that they understand that their behaviour or actions at that time were correct. Reinforcement can be as simple as compliments like “good job for keeping your toys!” or “good job for eating your peas”. You can also give them tickles or access to their favourite toy or activity, but make sure you emphasise why you are doing so.

Vocal play to functional language

Begin by making the first sounds of your child's favourite items and activities. For example, when asked to blow bubbles, say “b” for  “bubbles”, or “o” for "open the door". Start by having your child make single word request, then gradually progress to phrases and, eventually, sentences.

It is also critical to practise maintaining consistent eye contact when making requests. Large and immediate positive reinforcement will encourage your child to speak up more. Children require opportunities to express themselves and ask for what they want and need. If children are automatically given what we thought they wanted and needed without prior known requests, they will never feel the need to ask, because it will be provided before any requests are made. As a result, it is critical to provide opportunities and allow your child to make meaningful requests using gestures, sounds, and words to help them understand the value of making requests.

Strengthen eye contact

When giving something to your child, begin by holding it up to your face. Your child will look you in the eyes as he or she reaches out for it. Celebrate when your child looks at you, especially if it is unexpected, to encourage more of the same. You can do this by saying things like "I like the way you look at me!" or "nice looking!" and then clapping or giving a thumbs up to emphasise the praise if necessary. You can also lower yourself to your child’s eye level. This will reduce your child's stress and increase the likelihood that he or she will look at you.

Be consistent and give it time

Early intervention can help a child's development as a whole and make it easier for them to fit in socially over time. Children with autism develop at different rates and may take longer than others. The key to effective intervention is sticking to the programme and giving your child and the service provider enough time to grow together. Your child will grow tremendously with these two elements in place.

This article was written by Emuna House.

Emuna House is an inclusive, child-centred learning organisation. They provide programmes designed for both typical and atypical children from as young as 15 months to 14 years of age, particularly for children who are on the Autism Spectrum. These programmes focus on building and strengthening base skills to allow progress to mainstream schooling and to better participate in society. All their programmes have Applied Behaviour Analysis (ABA) therapy principles and techniques at their core. This approach enables them to discover and improve each child’s base skills, and repeat. Progress is made with gradual, but consistent, adaptation, fine-tuning, and goal-setting. They follow the progress of each child meticulously and encourage open communication between their team and their children’s families. They work together to provide a well-balanced and strong support system for the child as he or she learns to navigate the world.

Contact information: +65 9012 4694

The importance of baby teeth

By Dr. Ashley Thean
Obstetrician and Gynaecologist
B.D.S (Melbourne)

Baby teeth, also called "deciduous teeth," are a part of a child's health that is often overlooked. Many parents believe that deciduous teeth are not overly important, that they are just a temporary stage before being replaced by adult teeth. But the baby teeth are important for the growth of the adult teeth and for the child's speech, function, and a beautiful smile. Tooth decay can lead to abscesses in a child's mouth, an infection that leads to pain and discomfort. Treating tooth decay as a dentist may then require extractions or pulpectomies (nerve treatment for deciduous teeth), and these possibly negative experiences may alter the child's perception of the dentist, leading to avoidance of dental issues out of fear as they grow up.

To keep the baby teeth healthy, it is important to pay attention to the child's diet, how often they brush their teeth, how much fluoride they get, and how often they go to the dentist.

What are some important things to look out for as my baby is growing?

1) Teething

Teething is a group of symptoms that can happen when baby teeth come in. These symptoms vary, from red and swollen gums, lack of appetite, discomfort, drooling, as well as difficulty in sleeping. If these symptoms are observed, please consult your pediatrician as there may be other issues at hand.

Ways to combat a teething baby include rubbing the baby's gums with a clean finger or wet cloth, or giving them cold teething rings or toys. If you intend to give your baby medication such as pain relief or numbing creams for the gums, please check with your paediatrician first.

 2) Injury to your baby's mouth

If an injury occurs to your baby's mouth, you should contact your dentist immediately. This is so we can look at your teeth and figure out the best way to treat you. If your child is in pain and the tooth is chipped or broken, you may want to give mild pain relief and, if possible, bring the tooth fragment to show your dentist.

If the tooth is completely knocked out of the mouth, take the tooth to your dentist immediately. Try to be as gentle as possible with the tooth and store it in milk until your dental appointment.

 3) Thumb sucking

You should not allow your child to suck their thumb beyond the age of four. Thumb sucking at an older age leads to crooked, crowded teeth and bite problems. This can also happen if the baby uses the pacifier for a long time. In the future, they may need orthodontics to fix their bite.

Dental decay and diet

Dental decay can manifest as dark, coloured lesions on the surfaces of the teeth. According to the National Dental Centre (Singapore), early childhood caries (ECC) affects 40% of our preschoolers. ECC is a severe form of dental decay that can make it difficult for children to eat or sleep well.

Looking after the child's diet is of utmost importance. As a parent, you have full control over the child's diet for the first few years; foods containing sugar should be avoided as much as possible. When you put sugar in your mouth, bacteria in dental plaque turn this sugar into acid, which is strong enough to cause tooth decay. Sugar can last up to 20 minutes after a snack has been finished, and this is why it is important to not only limit sugar in the diet but to avoid snacking as well.

Children should try and eat a well-balanced diet, sticking to core foods and having three proper meals a day. Any snacks should be limited to meal times. This is because excess saliva produced during meals can help wash away the extra sugar and acid that cause tooth decay. If your child did have something sweet to eat, try to brush their teeth right away. If this is not possible, drink lots of water or rinse the mouth with water.

The most frequent cause of ECC is letting your baby fall asleep with a bottle of milk or any other sugary drink. Parents should try and avoid overnight feeding as milk can pool in your child's mouth and stay on their teeth. This allows for the formation of acid-producing bacteria. Combined with the fact that saliva flow is greatly reduced at night, this bad habit can lead to rapid destruction of tooth structure.

At what age does my baby need to start brushing?

Good oral habits should begin at a very early age, even before the first tooth arrives. Start cleaning your child's mouth now, even if they do not have any teeth yet. Do this by gently wiping the mouth clean with a wet cloth or a small thimble-like soft rubber device that fits over your index finger to rub off excess food.

Once the first tooth erupts at about six months, brush the teeth twice daily with a toothbrush. Start children with a small, soft-bristled, colorful toothbrush with a big handle. Use a circular wiggling motion, especially where the tooth meets the gums. From the age of two, or once your child knows how to spit, start them with a pea-sized amount of low-concentration fluoride toothpaste. You can ask your family dentist to demonstrate proper toothbrushing at your child's first dental visit. Parents should always watch their kids brush, and every three months, they should get a new toothbrush.

Is fluoride good for me?

Fluoride is beneficial for preventing cavities and strengthening tooth enamel. It is in the tap water in Singapore, in toothpaste, in some mouth rinses, and in gels and varnishes that are put on by professionals.

While fluoride provides a wide range of benefits, its use in children must follow recommendations according to the child's age. When teeth are still in the developmental stages, excessive use of fluoride can lead to fluorosis, a process that changes the way teeth develop. Fluorosis can be mild and only change the colour of the tooth, or it can be severe and make the whole tooth brown and weaken the tooth.

For children under the age of 6, fluoride tablets, gels, and mouth rinses are prohibited under the European Acaedmy of Paediatric Dentistry (EAPD), American Dental Association (ADA), as well as the Australian Dental Association (ADA). This is especially so in Singapore as our tap water is already fluoridated at 1 part per million (ppm), and additional fluoride supplements may not be necessary.

Age group	Concentration of fluoride in toothpaste	Amount
6 months to 2 years	500 ppm	Pea sized
2 to 6 years	1000 ppm	Pea sized
6 years and up	1450 ppm	1-2 cm

EAPD recommended guidelines for toothpaste use in children

Young children have a high tendency to swallow toothpaste, so you should only switch to a fluoride-containing toothpaste once your child is able to spit. For all children below the age of six, toothpaste should be used under adult supervision.

It is imperative to balance the protective effect of fluoride against dental caries and to also minimise the risk of fluorosis. For children with rampant dental decay, you may consider additional fluoride-related treatment modalities based on the advice of your dentist. For more information about the oral health benefits of fluoride, please ask your dentist.

When should be my baby's first visit the dentist?

The first visit to the dentist should be right after his or her first birthday. At your child's first appointment, the dentist can keep you informed about caring for your baby's first few teeth, offer advice regarding oral hygiene recommendations, diet and nutrition, and inform you on how to avoid possible problems.

The second visit should be when your baby is 3 years old, when the full set of the deciduous dentition has erupted (20 teeth in total). The goal of this visit is to look at all the baby teeth to see if they are decaying or if there are any problems with how they are growing. A preventive dental programme may then be redesigned based on these findings.

Subsequent dental visits should then continue every 6 months. At every appointment, the dentist will continue to review your child's dental growth and development and will adjust the preventative programme tailored to your child. If necessary, fluoride treatment may be recommended at this stage.

The first few appointments your child goes through play an important role in their subsequent dental visits in the future. Children need to experience the clinical environment and slowly grow accustomed to seeing the dentist. Look for a dental clinic that is child-friendly, patient, gentle, and focused on your child's specific needs.