Category Archives: maternal and child health

Local Public Health Spreads Importance of Good Oral Health during Children’s Dental Health Month

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston, Texas

The oral cavity, including the teeth and surrounding structures, are necessary for adequate nutrition, proper speech and a positive self-image.  Although tooth decay is largely preventable, it continues to be the most common chronic disease of early childhood.1  Dental health can impact school performance when a child has untreated tooth decay with resulting pain that affects their ability to concentrate, sleep at night or even attend school, “more than 51 million school hours are lost each year to dental related illness.”2 Taxpayers share approximately 11% of the $113.5 billion spent nationally on dental care expenditures, a percentage that has increased over the years as dental care utilization continues to increase among children.3  Children with cavities in their primary (baby) teeth are three times more likely to develop cavities in their permanent (adult) teeth which could contribute to broader health problems including diabetes and cardiovascular disease.4

All year long, many local health departments work to ensure children have access to quality oral health care. February is Children’s Dental Health Month, a time to spread awareness of good oral health habits and highlight the importance of beginning and maintaining oral hygiene in the early childhood years as soon as the first tooth appears.

Start Oral Care Early

In children, maintaining oral health is critical, even before adult teeth begin to form. The way in which primary or “baby” teeth are cared for shapes the way permanent teeth develop, making it important for children to learn effective oral health habits early. The type of care primary teeth receive can affect a child’s speech development, how they chew, and their confidence. Cavities are very common among children in the U.S. Untreated cavities lead to infections that can cause difficulties with eating, speaking, and even learning. A more serious and painful consequence of improper maintenance of primary teeth is formation of an abscess. When an abscess occurs, pus accumulates in a cavity to block an infection from spreading. This accumulation typically causes swelling and can be very painful.5

Making Oral Health a Priority for Children with Special Healthcare Needs

Over ten million children in the U.S. have special healthcare needs.6 Oral healthcare has been identified as one of the most common unfulfilled requirements among children with special healthcare needs (CSHN). Over the years, healthcare and public health professionals, lawmakers, and other advocates have been working to improve access to oral healthcare for CSHN.

NACCHO hosted a webinar titled, “Oral Health Considerations for Children and Youth with Special Health Care Needs,” which focused on oral health problems in CSHN, identified barriers to care, and brainstormed ways to address needs. The webinar also highlighted state and local examples that are working to improve the oral health of CSHN.

Local Health Departments Bridge Access to Dental Care

Luckily, cavities and other oral diseases are preventable through daily brushing with fluoride toothpaste, dental sealants, fluoride varnishing, and fluoridated tap water. Local health departments across the nation are playing their part in promoting good oral health through dental care services and programs.

In 2017, the Clinton County Health Department (CCHD) in New York won NACCHO’s Model Practices Award for their initiative to implement a fluoride varnish program in 100% of pediatric primary care practices in the county for children under the age of five. Their goal was to decrease the number of early childhood cavities and prevent developmental delays, diseases, self-esteem issues, and the prevalence of tooth decay in adulthood. CCHD staff worked with the New York State Association of County Health Officials to learn an overview of implementing a fluoride varnish program including application and billing. Once CCHD staff was trained, 100% of the pediatric provider offices were trained on screening, assessment, proper application, possible barriers, billing, and research, and all agreed to implement fluoride varnish application in their practice.

In Tioga County, NY, the Tioga County Health Department established a school-based mobile dental services program, designed to provide preventive and restorative dental care for underserved children and adults who lack insurance and access to a dental provider. Throughout the school year, the mobile unit travels to schools throughout the county and in the summer, it is stationed at a community center. Mobile unit dental staff perform exams, cleanings, fillings, x-rays, sealants, extractions, and fluoride treatments. Since the program’s inception, thousands of clients have received dental care through this program, many of whom had Medicaid, CHIP, or no insurance at all.

Throughout Harris County, TX the Harris County Public Health (HCPH) Dental Health and Prevention Services utilizes a multifaceted programming approach to improve the oral health of children. The dental programming includes:  dental clinical services for children, adolescents and expectant mothers; a population based oral health education and promotion program that reaches 15 school districts and over 300 schools each year and a school-based early prevention program which provides oral health education, oral assessments, fluoride varnish treatments, referrals and case management to thousands of children in underserved populations throughout Harris County. Recently HCPH embarked on this mission of “taking public health to the public” and acquired several mobile units that can provide a variety of public health services and education where people live, learn work, worship and play. Our Mobile Dental Unit will allow increased opportunities to provide access to dental care for children and promote the importance of oral health at community events.

NACCHO and CDC Launch Joint Local Water Fluoridation Project

The Centers for Disease Control and Prevention (CDC) says, “Children living in communities with fluoridated tap water have fewer cavities than children whose water is not fluoridated.”1 Water fluoridation can be delivered to whole communities regardless of income level or access to oral care. In January 2017, NACCHO, together with the CDC, launched a program called, “Building Capacity for Oral Health: Fluoridation Equipment in Local Communities,” which offers funding and technical assistance to support the replacement of aging water fluoridation equipment or the installation of new equipment. Nearly 30 organizations across 13 states applied, signifying the need for the project. Ultimately, six applicants were awarded based on their community’s need. In all, the oral health of nearly 450,000 people will be positively affected. In October 2017, NACCHO and CDC opened another round of funding for community water fluoridation systems. A total of 17 organizations were awarded funding, furthering efforts in providing communities with fluoridated water, thus improving and maintaining oral health.

Preventing Oral Health Problems

While public health professionals and policymakers work to address barriers in access to dental care, parents and caregivers can prevent oral health problems in their children by ensuring they drink fluoridated water, applying fluoride varnish and dental sealants to teeth, and simply brushing with fluoridated toothpaste. This National Children’s Dental Health Month, let’s champion optimal oral health among all children and promote healthy dental habits, so that America’s children have equal opportunities for success.



  1. Centers for Disease Control and Prevention. 2015. Oral Health Basics. Retrieved from
  2. S. Dept of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, Md. U.S. Dept of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000:12.
  5. Children’s Dental Health. The Importance of Caring for Baby Teeth. Retrieved from
  6. Maternal and Child Health Bureau. 2007. The National Survey of Children with Special Health Care Needs Chartbook 2005– 2006. Rockville, MD: Maternal and Child Health Bureau.

Story From the Field: Children’s Home Society of Florida

By Shannon Currie, MSL, Community School Director, Children’s Home Society of Florida and Harumi Reis-Reilly, MS, LDN, IBCLC, Lead Program Analyst, Breastfeeding Project, Safe, Healthy and Resilient Communities, NACCHO

Meeting Teen Moms Where They Are: An Innovative School-based Breastfeeding Program

Children’s Home Society and Commonsense Childbirth engaged the community of Pine Hills from community-based partnerships designed to demonstrate improvement in breastfeeding practices for registered participants in the early post-partum period, at 6 months and 12 months, as compared to 2013 statistical data collected from the Florida Department of Health. Children’s Home Society (CHS) of Florida provided Wellness Coaches to deliver peer lactation support and education through direct referral and online support through the Peer and Online Lactation Support (POLS) portal. Continue reading

Laying the Infrastructure for Breastfeeding Partnerships in Lee County

By Emily Bernard, IBCLC, NACCHO consultant in collaboration with Carol Lawrence, PhD, MS, BSN, RNC-OB and Lori Riddle, Lori H. Riddle, RD, LD/N, CLC  Florida DOH and Lee Health


The Florida Department of Health in Lee County (DOH Lee) worked alongside three hospitals during NACCHO’s Reducing Breastfeeding Disparities through Peer and Professional Support project. DOH Lee’s project was designed to improve the county’s environment to support breastfeeding for black families through the establishment of a strategically developed coalition, as well as through the provision of advanced training of agency and hospital staff, other than nurses, to improve breastfeeding support within the hospital and the community. DOH Lee helped to implement the EMPower Breastfeeding Project by providing prenatal education and postpartum support to low-income, black families delivering in these enrolled hospitals. Continue reading

Shifting Internal Policies and Systems to Create Breastfeeding Continuity of Care

By Carmen Vergara, RN, MPH (ESPERANZA HEALTH CENTERS) and Harumi Reis-Reilly, MS, CNS, CHES, IBCLC (NACCHO)  

Esperanza Health Centers, a former grantee of NACCHO’s Breastfeeding Initiative, is a Federally Qualified Health Center (FQHC) on the Southwest side of Chicago. The main population served is predominately low-income and Latino, and families in Esperanza’s service area experience significant economic, educational, and health inequities. Over 70% of area residents live 200% below the poverty level. Esperanza’s main services are adult primary care, pediatrics, prenatal care, and behavioral health. Additional public health services include programs related to children’s weight management, diabetes management, and physical activity. Continue reading

Removing Barriers to Breastfeeding in Niagara County

istock_000000346530_mediumBy Elaine Roman, MA, BSN, RN, IBCLC, ANLC Director, Division of Public Health Planning and Emergency Preparedness, Public Information Officer & Elise Pignatora, MS, CLC Public Health Resource & SNS Support Officer, Niagara County Department of Health

For the past three years, Niagara County (NY) Medical Reserve Corps (MRC) has received the MRC Challenge Award from the National Association of County and City Health Officials (NACCHO) for their breastfeeding initiative, “Energizing Partnerships to Advance Support Networks for Breastfeeding Mothers.” Director of the Division of Public Health Planning in the Niagara County Department of Health Elaine Roman, MA, BSN, RN, IBCLC, ANLC and Public Health Resource and SNS Support Officer Elise Pignatora, MS, CLC led the lactation initiative. The Niagara County Department of Health’s inspiration for this intervention to the 215,000 population community came from the 2011 Surgeon General’s Call to Action to Support Breastfeeding.  “We also looked at the Healthy People 2020 numbers and realized our county was not performing the way we would like it to be in regards to initiation, duration, and exclusivity of breastfeeding in our county,” Roman said. Continue reading

Using Triple P as a Model to Engage Communities and Prevent Child Maltreatment

By Calondra Tibbs, MPH, Senior Director, Safe and Healthy Families, NACCHO

Positive relationships between caregivers and children play an important role in the health and well-being of children throughout their lives. Establishing safe, stable, and nurturing environments and relationships and limiting exposure to adverse experiences (e.g., trauma, abuse, and neglect) can potentially reduce poor health outcomes and behaviors in a child’s adolescent and adult lives.1 The Adverse Childhood Experience (ACE) Study demonstrated that increased exposure to maltreatment can increase risk for alcoholism and alcohol abuse, illicit drug use, liver disease, smoking, unintended pregnancies, and chronic obstructive pulmonary disease.1 Continue reading

National Breastfeeding Month: Reducing Disparities through Peer and Professional Support

By NACCHO’s Safe & Healthy Families Team

August is National Breastfeeding Month, a time to focus on promoting and protecting breastfeeding in the United States. Public health workers hope to use the month-long spotlight to generate awareness about the importance of breastfeeding, help ensure access to necessary lactation care and services for all women, including those in the workforce, and support all present and future breastfeeding mothers.

Breastfeeding is one of the most effective ways mothers can prevent disease and protect the health of their infants. Continue reading