Definition
Oral hygiene for neonates refers to the care and maintenance of a newborn’s oral cavity to prevent infections, support feeding readiness, and promote overall health. It involves gentle cleaning, hydration, and monitoring for oral conditions to ensure proper development.
Key Aspects of Neonatal Oral Hygiene
- Gentle Cleaning: Using sterile gauze or a soft cloth to remove milk residue and bacteria.
- Colostrum Swabbing: Applying colostrum to the oral mucosa for immune benefits.
- Monitoring for Oral Thrush: Checking for white patches that may indicate fungal infections.
- Hydration Maintenance: Ensuring adequate fluid intake to keep the oral mucosa moist.
- Care for Intubated Neonates: Preventing mucosal damage and ventilator-associated infections.
Indications
- Helps maintain a clean and moist oral cavity, preventing complications.
- Stimulates oral reflexes (sucking, swallowing, and gag reflex).
- Prepares neonates for breastfeeding or bottle feeding.
- Removes milk residue and secretions that can harbor bacteria.
- Ensures comfort and hydration of the oral mucosa.
- Prevents dry mouth caused by oxygen therapy or mechanical ventilation.
- Reduces the risk of mucosal damage due to prolonged intubation.
General Principles
- Inspect the mouth at least daily, noting the presence of Candida, ulcers, breaks in oral mucosa, saliva consistency, condition of teeth, tongue, gingival, and lips.
- Note pain or difficulty in using voice or swallowing.
- Consider using an assessment tool.
- Commence brushing routine with eruption of first teeth.
- Brush child’s teeth at least twice a day.
- Help and supervision will be required until around the age of 7 years.
- Antibacterial mouthwashes and antifungal preparations may be necessary for some children.
Equipment Needed
A clean tray containing:
- Soft pediatric toothbrush.
- Fluoride toothpaste.
- Jug with water
- Sterile water (for <1 year baby).
- Gauze pieces in bowl.
- Glycerin.
- Torchlight to assess the condition of oral cavity.
- Kidney tray.
Preparation
- Explain the procedure to the child.
- Assess the condition of the mouth and need for care.
- Encourage the involvement and self-care where appropriate.
Procedure
| Gentle Cleaning | Use a soft, damp cloth or sterile gauze to clean the gums and tongue. Avoid using toothpaste in neonates. | Prevents buildup of milk residue and bacteria, reducing the risk of oral infections. |
| Colostrum Swabbing | Apply colostrum to the neonate’s oral mucosa using a sterile swab. | Provides immune protection and promotes early gut colonization with beneficial bacteria. |
| Monitoring for Oral Thrush | Observe for white patches on the tongue and inner cheeks. Report any abnormalities. | Early detection of Candida infections allows timely treatment and prevents discomfort. |
| Hydration Maintenance | Ensure adequate fluid intake to prevent dry mouth. | Keeps the oral mucosa moist, reducing irritation and promoting comfort. |
| Care for Intubated Neonates | Perform oral suctioning and apply prescribed antiseptic solutions as needed. | Prevents ventilator-associated pneumonia and maintains oral hygiene in neonates on respiratory support. |
| Referral to Specialists | Coordinate follow-up with pediatric dentists or neonatologists for high-risk neonates. | Ensures specialized care for neonates with congenital oral conditions or feeding difficulties. |
- Perform hand hygiene.
- Gently brush teeth and gums with pediatric toothbrush and fluoride toothpaste for at least 2 minutes; use tiny smear of toothpaste and pea-sized amount for children.
- Encourage the child to spit after brushing; if they are able to, do not swallow.
- Rinse mouth with water (use sterile water for babies <1 year); if child is unable to spit, gauze or swab may be used for this purpose or moisturizing the mouth.
- Orally intubated children should, where possible, have endotracheal (ET) tube moved to alternate side of the mouth daily.
- Apply emollient to lips.
Post procedure Care
- Praise the child for cooperation.
- Replace the articles and discard the wastes.
- Record the procedure with date and time and observations made in oral cavity.
Special Consideration
- Applying colostrum to the oral mucosa can stimulate oropharyngeal lymphoid tissue, enhancing immunity.
- Neonates in NICU settings are at higher risk for nosocomial infections.
- Proper oral hygiene reduces the risk of oral thrush and systemic infections.
- Use soft materials like sterile gauze to avoid negative oral sensory stimulation.
- Avoid harsh chemicals or alcohol-based solutions that may irritate the mucosa.
- Encouraging parents to participate in oral care fosters bonding and sensory development.
- Parents should be informed about the benefits of colostrum and gentle oral hygiene practices.
- Intubated neonates require special oral care to prevent ventilator-associated pneumonia.
- Regular oral assessments and moisturizing the mucosa help maintain oral health.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Naveen Bajaj, Rajesh Kumar, Manual of Newborn Nursing, 2nd Edition, 2023, Jaypee Publishers, ISBN:978-9354659294
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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