Children's Oral Health-related Behavior and Attitudes: Are Proxy Assessments Valid?

Objectives: Assessing children's oral health-related behavior and attitudes with parents' proxy assessments is quite commonly used in empirical research. The objectives were to determine (a) if children's and parents' responses concerning children's oral health-related behavior and attitudes are correlated, and (b) if children's and parents' responses are consistent over a three month period.
Methods: Data from 28 7-11 year old children and their parents were collected at a baseline orthodontic appointment, and one month, two months and three months later. The children received oral health-related education at the appointments.
Results: At the baseline appointment, children's and parents' responses concerning how often the child's teeth get brushed (r=0.51;p<0.01), how well the child's teeth get brushed (r=0.45;p<0.05) and how often the child's teeth get flossed (r=0.52;p<0.01) were significantly correlated. While the significant correlations between children and parent responses for flossing related behavior persisted over time (Month 1: r=0.59; p<0.001: Month 2: r=0.78; p<0.001; Month 3: r=0.58; p<0.01), brushing related responses did not correlate significantly at Month 1 and Month 3. Children's responses concerning their oral health-related attitudes (e.g., "How important it to you to take care of your teeth?", "...have a nice smile?") and the parents' responses concerning their child's attitudes did not correlate significantly at any time point. Children and parents' diet-related responses correlated only at the Month 3 appointment (r=0.57; p<0.01).
Conclusions: Relying on parents' proxy assessments of their child's oral health-related behavior should be considered in the context of oral health education interventions their child receives. In this case, the monthly orthodontic visits with oral health promotion education might have affected the attention parents gave to different oral health-related behaviors. Parents' proxy assessments of their child's aoral health-related attitudes should not be considered as valid.