Brush, Book, Bed – The Best Bedtime Routine

A guest blog post by Michelle Steffen, MD, FAAP,
Pediatrician, Riverside Pediatrics, Georgetown, SC, and Lauren
Barone, MPH, Manager, Oral Health Initiatives, American Academy of
Pediatrics, Elk Grove Village, IL

IMGBrush, Book, BedWe
know good habits start early. From good nutrition to early
literacy, the foundation for health is laid even before birth. For
many years, Reach Out and Read, has promoted the importance
of early literacy and spending time reading to our children.
Recently, the American Academy of Pediatrics (AAP), has been
collaborating with Reach Out and Read, testing out a new program, Brush, Book, Bed
(BBB), that recommends tooth brushing and reading aloud as part of
children’s bedtime routines.

The BBB program provides a simple, “sticky” message for
pediatricians to help families understand the importance of good
routines for young children, especially tooth brushing, reading
together, and getting to bed at a regular time each night. But BBB
isn’t only for families, it is also a way to help providers
communicate more than one health message in a single delivery. By
implementing BBB and providing families with a goodie bag that
includes a toothbrush, fluoride toothpaste, and an age-appropriate
oral health focused book, providers can talk with parents about
good oral hygiene, early literacy, and making sure the child is
consistently settling down to sleep at a regular time.

During a pilot study that the AAP conducted in Reach Out and Read sites across
the country, staff completed an online oral health training for
medical professionals and also the Reach Out and Read online
training course. An
implementation guide
was also made available. Results showed
that BBB can be implemented in a number of settings and that the
message is both effective in helping families understand the need
for nighttime routines and in providing messaging for pediatricians
to talk to their patients about oral health. Results from
the pilot study were encouraging with approximately a 20% increase
in pediatricians talking about oral health, a 40% increase in
fluoride varnish application, and a 10% increase in parents
reporting that they brush their children’s teeth.

We received some wonderful quotes from medical providers
involved in the study:

“The Brush, Book, Bed program integrates seamlessly into my day
to day practice.  I have always discussed the concepts of a
consistent bedtime, oral health, and literacy in my well-child
exams, but with the Brush, Book, Bed program, I am able to deliver
my message with a unified theme, and it actually seems to save
time.  The best part of the project is being able to offer the
tools needed to implement the recommendations with the book,
toothbrush, and fluoride toothpaste.
Parents appreciate this greatly, and it drives the concepts
home more concretely.  I would love to see the Brush, Book,
Bed program in pediatric offices across the country.”

“With the early visit talking about night time routine
linking it to the book and brush made it an easy way to get all of
those topics in a quick manner”

“Having a toothbrush and toothpaste was a great prompt to talk
about oral health”

“it makes the conversation about oral health easier to