1. In the last week, how often did you offer your child sugar-added foods, such as:
- Lollipops, candies, chocolates, honey, stuffed biscuits, cornstarch biscuits, and cake.
- Toddynho®, boxed juice, fruit juice with sugar, soft drinks, and Danone®
- Milk, porridge, or smoothie prepared with sugar, Mucilon®, Milnutri®, Neston®, Cremogema®, Farinha Láctea® or chocolate powder |
a) I offered some days but not all days of the week
b) I offered one to three times a day during the week
c) I offered four or more times a day during the week
d) I did not offer any of these foods during the week |
| 2. Has your child’s mouth ever been examined by a dentist (teeth, gums, and tongue)? |
a) Yes
b) No |
| 3. Does your child already have teeth? |
a) Yes
b) No
Instructions for the instrument’s administrator:
- If the caregiver answers “yes”, go to question 4 of the Practice domain.
- If the caregiver answers “no”, go to question 13 of the Practice domain. |
| 4. Has your child ever suffered a blow to the teeth? |
a) Yes
b) No
*If “yes”, did you take your child to the dentist? a) Yes b) No |
| 5. How do you relieve the itching caused by your child’s teething? |
a) I give a pacifier with honey or sugar
b) I give an iced teether
c) I give some cold food
d) I apply anesthetic ointment on my child’s gums
e) Other:__________________ |
| 6. Do you clean your child’s teeth? |
a) Yes
b) No
Instructions for the instrument’s administrator:
- If the answer is “yes”, go to question 7 of the Practice domain.
- If the answer is “no”, go to question 13 of the Practice domain. |
| 7. What do you use to clean your child’s teeth? |
a) Diaper or gauze
b) Cotton
c) Finger cot
d) Toothbrush
e) Other:______________ |
| 8. How often have you cleaned your child’s teeth in the last week (last 7 days)? |
a) Never
b) Sometimes, but I don’t brush my child’s teeth every day
b) Once a day
c) Twice or more times a day |
| 9. How often did you floss your child’s teeth in the last week (last 7 days)? |
a) Every day
b) Almost every day
c) A few days
d) Not at all |
| 10. Do you brush your child’s teeth with fluoride toothpaste? |
a) No, I don’t even use toothpaste on my child’s teeth
b) No, the toothpaste I use on my child’s teeth does not contain fluoride
c) Yes, the toothpaste I use on my child’s teeth contains fluoride
d) I don’t know if the toothpaste I use on my child’s teeth has fluoride
Instructions for the instrument’s administrator:
- If the instrument is applied at the caregiver’s home, ask to see the children’s toothpaste used on the baby’s teeth to assess whether it contains or does not contain fluoride.
- If the answer is “c”, go to question 11 of the Practice domain.
- If the answer is “a”, “b”, or “d”, go to question 13 of the Practice domain |
| 11. Can you inform us whether the fluoride concentration in the toothpaste you use on your child’s teeth? |
*a) If yes, what is the concentration?
PPM/FLUORIDE: ____________
Instruction for the instrument applicator:
b) If the instrument is applied at the caregiver’s home, ask to see the toothpaste used on the child to identify the fluoride concentration if the caregiver responds that he cannot inform it:
PPM/FLUORIDE:_____________ |
| 12. How much fluoride paste do you usually put on your child’s toothbrush? |
a) The equivalent of a grain of uncooked rice
b) The equivalent of a pea grain
c) Half of the brush head
d) Whole brush head
Instruction for the instrument applicator:
- If the instrument is applied at the caregiver’s home, ask him to dispense the paste on the child’s toothbrush |
| 13. Do you breastfeed your child through your breast? |
a) Yes
b) No |
| 14. Has your child ever had any liquid from a bottle? |
a) Yes
b) No
*If yes, around what age did your child start using a bottle?
a) During the first 6 months of life
b) After the 60th month of life
c) I don’t remember
Instructions for the instrument’s administrator:
- If yes, go to question 15 of the Practice domain.
- If the answer is no, go to question 18 of the Practice domain |
| 15. Does your child still use a bottle? |
a) Yes
b) No
*If “no”, around what age did your child stop using a bottle and start using a cup?
a) During the first 12 months of life
b) After 120 months of life
c) I don’t remember
Instructions for the instrument’s administrator:
- If yes, go to question 16 of the Practice domain.
- If the answer is no, go to question 18 of the Practice domain |
| 16. How often did you offer your child the bottle to fall asleep or go back to sleep during the night in the last week? |
a) Twice or more times a night during the week
b) Once a night during the week
c) I offered my child a bottle some nights, but not all of the week
d) No night of the week |
| 17. When preparing your child›s milk, porridge, smoothie, or juice, how often did you add products such as Neston®, Farinha Láctea®, Mucilon®, Milnutri®, Cremogema®, chocolate powder, honey, or sugar in the last week? |
a) Twice or more times a day during the week
b) Once a day during the week
c) I added such products on some days, but not all of the week
d) No day of the week |
| 18. Has your child ever used a pacifier/nipple? |
a) Yes
b) No
*If yes, around what age did your child start using a pacifier/nipple?
a) During the first 6 months of life
b) After the 60th month of life
c) I don’t remember
*Instructions for the instrument’s administrator:
- If yes, go to question 19 of the Practice domain.
- If the answer is no, go to question 1 of the Attitude domain. |
| 19. Does your child still use a pacifier/nipple? |
a) Yes
b) No
*If no, around what age did your child stop using a pacifier/nipple?
a) During the first 12 months of life
b) After the 120th month of life
c) I don’t remember
*Instructions for the instrument’s administrator:
- If the answer is yes or no, go to question 1 of the Attitude domain. |
