Caring for the Oral Health of Children Experiencing Homelessness

Each year, over 1.2 million children from birth to age 6 in the United States (5% of all children in this age range) experience homelessness. Of these children, about 50,000 are enrolled in Head Start programs. Program types include Early Head Start, Head Start, Migrant and Seasonal Head Start, and American Indian and Alaska Native Head Start programs. Children experiencing homelessness are automatically eligible for Head Start services.

Rows of sleeping bags on floor of a school gym. According to the McKinney-Vento Homeless Assistance Act, homelessness is defined as lacking a stable, regular, and adequate nighttime residence. Children experiencing homelessness include those sharing housing with other people for economic reasons or because their family lost their housing. Children who live in motels, hotels, trailer parks, campgrounds, parks, emergency or transitional shelters, cars, public spaces, abandoned buildings, substandard housing, or bus or train stations are also considered homeless. For more information read Caring for the Health and Wellness of Children Experiencing Homelessness.

Families may become homeless for one or more of the following reasons:

Lack of affordable housing
Low wages and unemployment
High cost of housing, transportation, food, health care, and mental health and addiction-treatment services
Domestic violence and other unsafe living conditions
Emergencies and natural disasters like storms, tornadoes, hurricanes, landslides, and fires

Social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Housing is an important social determinant of health. The cost, stability, quality, and safety of housing can affect health. The physical environment, safety, and social makeup of the neighborhood where a family lives can also affect health, as can moving often and living in overcrowded conditions. Families experiencing homelessness may have difficulty obtaining food, so they may experience hunger or malnutrition. Children in these circumstances may also experience health challenges, including behavioral health issues; developmental delays; and mental health, oral health, and other health concerns.

Head Start programs serve many children who are experiencing homelessness. Staff play an important role in identifying these families and connecting them to resources to support their health, including their oral health.

Every family, regardless of whether they are experiencing homelessness, has a wealth of strengths that stem from their behaviors, beliefs, experiences, and values. Families are often doing many things to support their child’s health, and staff should recognize and honor their strengths. As Head Start staff form respectful and trusting relationships with families, it is important for staff to consider different cultural perspectives and how each family’s past oral health experiences and current situation may influence their family’s health behaviors.

Staff can share information about local, state, national, and federal programs that provide public benefits to families experiencing homelessness and help them sign up for services. Staff can also help connect families to community-action, culture-based, faith-based, and nonprofit organizations that support nutrition and oral health care for families experiencing homelessness.

Impact of Homelessness on Children’s Oral Health

Young girl brushing her teeth outdoors. Families experiencing homelessness may face barriers to meeting their child’s oral health needs, including accessing oral health care. These families may find it difficult to carry belongings, including toothbrushes and toothpaste. They may also have trouble finding places where they can brush their teeth or may lack access to safe drinking water.

Children experiencing homelessness, especially if they move often, are less likely to visit a dentist compared to children from families with low incomes who have stable homes. Lacking access to oral hygiene products and regular oral health care can lead to oral diseases and pain, which, in turn, can result in children having problems with eating and speaking, being distracted from learning, feeling embarrassed about their appearance, and missing school. Although most children experiencing homelessness are eligible to receive oral health care under Medicaid, not all children eligible for Medicaid receive oral health care.

Families experiencing homelessness may also have unreliable sources of healthy food, which can have a negative impact on their oral health. Families who cannot afford to buy healthy foods or do not have a kitchen to store and cook food may rely on prepared foods that typically are highly processed, low in nutritional value, and high in sugar. Children who frequently eat foods high in sugar are at high risk for developing tooth decay.

Tips for Supporting the Oral Health of Children Experiencing Homelessness

Promote access to healthy food. Staff can share information with families about federal programs that provide access to healthy foods, such as the Supplemental Nutrition Assistance Program (SNAP) and WIC. If families are interested, staff can help them apply. Because applying for benefits can take time, Head Start programs should have age-appropriate food items available or should partner with local churches or food pantries to meet urgent needs. The American Academy of Pediatrics’ and the Food Research and Action Center’s Screen and Intervene: A Toolkit for Pediatricians to Address Food Insecurity offers tips on how to identify, discuss, and help families address food insecurity issues they face.
Help obtain oral hygiene products and educational materials. Head Start staff can talk with families about whether they need toothbrushes and toothpaste and can offer to help families obtain them. Staff can keep oral hygiene products on hand and provide a space where parents can brush their teeth and help their child brush their teeth. Head Start programs can develop community partnership agreements with local dental offices or clinics to obtain donated toothbrushes and toothpaste. Staff can also share educational materials (books, videos) with families to help them teach their child about oral health. And they can hang oral health posters in centers that promote taking care of children’s oral health. State dental hygienist liaisons can help identify free or low-cost oral hygiene products and educational materials.
Help obtain dental insurance and identify a source of care. As staff build trusting and positive relationships with families, they can invite families to share the successes and challenges they face in accessing oral health care. If they need it, staff can help families enroll their child in Medicaid or the Children’s Health Insurance Program (CHIP). Family services professionals and home visitors often know of local oral health professionals and dental clinics or offices that provide oral health care to children enrolled in Medicaid or CHIP. Online databases, such as Find a Dentist, can help identify a dental office or clinic that accepts Medicaid or CHIP. In addition, many community health centers offer oral health care at no charge or on a sliding fee scale based on income.
Help schedule and keep dental appointments. Families may not have a phone or may be uneasy about calling a dental clinic or office to set up an appointment. They may also be unsure about what questions to ask or what information to share about their child’s oral health. Staff can help parents make an appointment or talk about their child’s oral health habits before they call or visit the dental clinic or office. Staff can also help families overcome barriers they may face in keeping dental appointments. For example, staff can partner with local oral health professionals to provide care at Head Start programs and other convenient locations for families. This may be very helpful for families living in rural areas.