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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


Brush, 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 (ROR), 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 ROR, 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 ROR 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 initiate"

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Written by Michelle Steffen, MD, FAAP; Lauren Barone, MPH at 14:30



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