We have a couple of patients in our pediatric dental practice who do not tolerate dental care well. They are younger than 5 and scream, flail (sometimes knocking over treatment trays), and basically cause a ruckusÑeven though their parents/caregivers are present. Such behavior upsets our patients and staff. What strategies do you suggest for dealing with these patients?
Anxiety, in the proper amount, is a positive and necessary emotion that alerts us to danger. Many children may associate a dental appointment with danger and, thus, display variable degrees of anxiety. Appropriate behavior guidance techniques hinge on dental professionals helping children learn to cooperate during treatment even when they are anxious. In addition, and of equal importance, dental professionals should help children learn to be willing to return for further dental care. Learning is a relatively permanent change in behavior that results from experience. Much of the behavior children exhibit in the dental office is the result of past learning experiences. When children associate experiences with pleasant events, they are willing to enter into new relationships. On the other hand, refusal of children to separate from their parents/caregivers suggests they may have had few positive experiences with others, or that the experiences were unpleasant. Children who have their desires fulfilled by displaying undesirable behavior are likely to use such tactics in the dental office.
Children Age 1 to 2: In this age group, children tend to exhibit basic fears such as separation anxiety and fear of strangers. In general, children age 1 to 2 are too young to be expected to cooperate during dental treatment. For this reason, the parent should accompany and perhaps hold the child during the initial examination. Sedation and physical restraint are frequently required to provide dental treatment to this patients in this age group.
Children Age 3 to 5: During this time of development, children are becoming more autonomous and learning to initiate new experiences and relationships. They are also learning to impose certain restraints on their behavior. This is the age when most children become actively able to participate in and cooperate during dental treatment. Children in the 3 to 5 age group want more autonomy, but they also need control and structure in their environment. If children are overwhelmed and feel they have no power in the situation, they may become anxious. As such, dental professionals need to communicate to children that they can play an active role in the treatment experience. Children can actively help by sitting still, keeping their hands out of the way, and opening their mouths wide. Dental professionals can show regard for children's needs for autonomy and initiative by providing them with as many options as possible.
Children's need for structure is easily combined with treatment in the dental office. The highly structured dental experience is helpful for many children who have not yet learned to impose restraints on their behavior. A child may be considered poorly behaved in a loosely structured environment, but when placed in a highly structured and closely supervised situation, the child's behavior may improve dramatically. It is essential that children clearly understand the boundaries of acceptable behavior that exist in varying situations. Children are much more comfortable when they are aware of behavioral limits that are firmly and consistently held. When caretakers are inconsistent in their setting of limits, children may develop behavior problems.
Children age 3 to 5 are often anxious regarding tangible, concrete objects. They may fear unfamiliar items that can be seen, heard, felt, smelled, or tasted. The "tell, show, do" approach may help alleviate these fears. While many children undergo dental treatment without tears, crying should be regarded as a normal response. The dental team needs to respond by considering the reasons behind the child's behavior. A significant aspect of effective behavior guidance is the art of determining the reason for particular behavior and selecting an appropriate response.