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Most parents fret about their kids' hygiene and how it is affected by factors like circumcision, tooth brushing, or toilet training. Said fretting escalates when the kids in question have special needs, but hygiene doesn't have to be the skunk cabbage in the special needs bouquet -- not if parents do their best to understand why our kids' hygiene can be complicated, encourage self-care, recognize that not all hygiene needs will be rooted in special needs, and help make self-care part of a routine.
Circumcision is a standby topic in parenting circles. While arguments both for and against the snip invoke culture, religion, sensation retention, or wanting daddy to have a penis twin, few mention the possibility of conditions like cerebral palsy or autism and how those affect uncircumcised penis care. I certainly didn't dwell on the possibility of special needs when I was pregnant with my son, so parents-to-be should consider this: some of our boys don't have the fine motor skills to retract their foreskins, while others lack the motivation for proper penis care -- even if they can understand terms like phimosis and balanitis. Some of us parents might have preferred, in hindsight, for our boys to be streamlined -- not only to simplify hygiene for the rest of their lives, but because our sons already struggle with the social rules contradicting Janice Joplin's blissful mantra, "If it feels good, do it." It is so tempting and so easy to pull on a foreskin from the outside of one's pants! Who can blame a kid for taking advantage of such an opportunity? And who outside our community of parents, peers, educators, and advocates won't judge them for doing so in public?
It's fun to pepper a post with the word 'penis,' but I have to admit that dental hygiene is a far greater concern than circumcision in my parenting circles. We resent furry teeth stereotypes, and do everything we can to avoid having them apply to our children. We are not without allies; lots of people want to help keep our kids' teeth healthy and strong, including the U.S. government, and autism advocates, and their advice is usually sound: Talk to the dentist beforehand, see if they'll let your child come in during slower times and tour the office. Have your child practice sitting in the chair. Have them watch another child's dental exam. Don't force them. Use social stories about going to the dentist. Get specialized toothbrushes.
This advice has stuck for many quirky kids I know; their attitudes towards dental hygiene are now indistinguishable from the typical little shirkers who avoid toothbrushing because it's a chore and chores suck, and who can be convinced to tolerate dentist visits.
But some kids with special needs will not submit to the dental care they need, despite their parents' efforts to reassure or accommodate them. They may improve like my son Leo, who now lets us brush and floss his teeth, and whose fear of the dentist used to result in screams as soon as he walked through her office door -- but who, through years of carefully managed behavioral baby steps, will now sit in the unpredictable up-and-down chair, has developed enough muscle control to keep his mouth open for almost a minute, and will usually allow the dentist to probe his mouth with her fingers. He's never tolerated any other dental procedures, not even the lightest of cleanings. We've been lucky; he has what his dentist calls strong healthy horse teeth.
And now that he's suddenly almost nine years old, his dentist wants him to have a full dental exam, with x-rays, cleaning, and teeth sealing. Since he can't sit still for these procedures and would likely find them terrifying, we have no choice but to put him under general anesthesia so his dentist can finally give him a thorough dental evaluation plus the treatments kids are supposed to get every six months.
Leo's dental needs are not uncommon or even particularly intensive compared to a friend's child's. His oral sensitivities and dental care non-compliance are so pronounced that his family uses Leo's anesthesiologist two times each year to get their son's teeth the care they need, including lots of sealing. Despite being medically necessary, such "voluntary sedations" are often not covered by insurance, have to be scheduled well in advance for limited time slots, require several hours without food (so fun with perpetually hungry boys), and have to be
