Table 4.

Saliva collection issues and problem solving strategies

Issues	Exemplary field notes
Food/drink	Saliva red-tinged on first collection, and child reported eating red candy approximately 1 hour earlier. Sample discarded and child instructed to rinse mouth out again multiple times. Saliva still slightly pink-tinged, but improved, so sample used.
	Child eating hamburger and drinking soda upon arrival, so saliva collection delayed until the end of the visit.
Developmental issues	Child was cooperative but unable to produce any passive drool during attempts, kept mimicking noises and mouth movements only. Collected saliva by swab.
	Child unable to provide saliva using passive drool method. After demo and multiple instructions, kept “blowing” into adapter with no saliva. Cotton swab was successful.
Behavioral issues	Child kept biting on the swab and laughing; mother retrieved swab from child’s mouth.
	Attempted saliva collection after 20 min of play. Used demo device; child tried but spit very small amounts and lost interest after multiple attempts.
Collection strategies
Help from parents	Child had difficulty with passive drool; was successful after coaching from father.
	Child reluctant to complete saliva collection despite multiple attempts; child kept refusing whenever asked to try by investigator. Mother coached her through it and she was successful.
	Child refused to provide sample for investigator; mother asked for a second cotton swab and demonstrated on herself, showing the child it was “like a lollipop.” Child kept swab in his mouth while mother had hers in as well. He then allowed mom to hold his swab and move it around his mouth until enough saliva was collected.
Demonstration and other strategies	Used demo to walk child through saliva collection. Child preferred to spit while I wasn’t looking.
	Child had difficulty with passive drool despite multiple attempts and instructions by both researcher and mother. Had child drool into a clean cup and poured saliva into appropriate tube.