Two's company — three's a crowd!

Feb. 1, 2002

I feel like banning every child from my treatment room so I can concentrate solely on the patient. How can I approach my boss and the parents without stepping on their toes?

Dear Dianne,I work in a very child-oriented general practice. We love children and try to make their experiences in our office positive and fun. We even take videos of the children on their first visit. We have always allowed parents to accompany the child if they wish. We understand that many children are fearful of the unknown.

However, there have been a few negative experiences lately that have made me rethink this policy. Recently, a mother and small child accompanied a 14-year-old into my operatory. The child became restless, and the mother let her down from her lap. The child then ran amok; she stepped on the dental chair's foot control and pinned my legs underneath it. I have also had children fighting in the room while I worked on their mother.

We provide plenty of toys and videos in the waiting room, but some parents seem uncomfortable leaving their children there. The result is I am stuck with unruly children running in and out of the room, jumping on the chairs, opening drawers, and generally going haywire.

I feel like banning every child from my treatment room so I can concentrate solely on the patient. How can I approach my boss and the parents without stepping on their toes?

Frazzled in Frisco

Dear Frazzled,Hygienists the world over have experienced this same frustration! We don't want to offend patients by denying their request, but we resent their lack of trust, plus the ensuing distraction.

Your inquiry prompted me to search for an established protocol dealing with extra people in the operatory. I searched the CDC Web site and sought advice from my colleagues at several universities. Apparently, there are no written guidelines on this issue. What I did learn is that practice owners are free to establish their own criteria. Some doctors have done so, providing written guidelines that state unauthorized persons are not allowed in treatment areas. Other doctors feel having extra people is permissible as long as those people do not distract or interfere with treatment.

From a practical standpoint, extra people in the operatory can be an unwelcome distraction as well as a nuisance for the very reasons outlined in your letter. Allowing parents in the operatory interferes with your ability to build rapport with the patient, especially when the parent insists on answering the questions you direct to the child. Babies cry, and small children become restless while waiting on a brother or sister. Potentially dangerous situations, such as children or parents handling equipment, becoming tangled in wires or cords, or being exposed to airborne pathogens, should also make practitioners rethink this policy.

Sometimes, parents will bring their small children to "observe" mom or dad receiving preventive care. These well-meaning parents do not understand that it may not be healthy for little Sally to see those sharp instruments going into mom's mouth and the bleeding that occurs. Although the parent may be quite calm, the child may interpret it as something "bad" happening to mommy. One doctor shared the following horror story:

"Since I don't treat many children, I don't have the problem of parents in the operatory. However, I did have many stay-at-home moms bringing their preschool children with them. Because I have no full-time babysitters on salary, these children would often accompany their mom to the operatory. One day, a three-year-old, who was perched next to the operatory chair, suddenly reared up and cracked his head open on the swing arm of the bracket tray. This required a visit to the emergency room for stitches. Shortly after that, another mom was having some facial restorations done. Just as I was contouring the gingival margins with a high-speed diamond, her five-year-old child jumped on the bottom of the operatory chair, causing mom to recoil her legs. This caused me to sink the bur in her gum all the way to the hub. Luckily, she was very numb. After my face returned from the death-ashen color to somewhat embarrassed red, I vowed never to let another child in the operatory while working on the parent. I now have a sign on the door leading to the treatment area that states: "Due to liability issues, and for your protection, children will not be allowed in the treatment room with parents."

From another doctor:

"I usually allow a parent into the treatment room if the child is young and the presence of the parent helps calm the child. I had a three-year-old in today accompanied by his dad. He sat next to the child and held her hand. Without him, I don't think I could have completed the exam. In another situation, I didn't allow a mom into the treatment room. She had two other kids that were acting up a bit. She yelled at them loud enough so everyone within a city block could hear, "If you kids don't cut it out, I'm going to have the doctor come and give you a shot!"

Another doctor encourages parents to be a part of their child's appointment. He wants the first visit to be a special ocassion for the parent and child. When parents and siblings want to accompany a brother or sister, this doctor allows them to come back to the treatment area and see the room. Then, he allows them to watch from the hall. Often, they will drift back out to the reception area.

I called the pedodontist who treated my own children to find out how he handles this problem. He has a very interesting tactic. If parents insists on accompanying their child, he seats them in a room adjacent to the treatment area. After the child is seated in the dental chair, he picks up the loaded syringe, goes into the room where the parent is, and sits down directly in front of the parent. Without a word, he holds the syringe up and uncaps the needle. A look of horror usually comes over the parent's face, or the parent looks away. He then says, "So, what you are telling me is that you want your child to see the look of horror that I just saw. Do you think this would be good for him/her?" He said he then goes on the explain that it's best for both parent and child if the parent shows trust, and that nothing is going to be done that this parent has not experienced. He tells me this is very effective.

Obviously, doctors and hygienists have different tolerance levels for onlookers in the treatment area. Some are entirely comfortable with the presence of parents and siblings, while others feel annoyed and distracted. However, due to the potential for danger, I feel it is better to require those who insist on accompanying the patient to sit just outside the operatory.

Dealing with overly-protective parents can be tricky. I urge you to sit down with your employer and come up with written guidelines that address this problem before you experience an unfortunate accident.


Dianne D. Glasscoe, RDH, BS, is a professional speaker, writer, and consultant to dental practices across the United States. She is CEO of Professional Dental Management, based in Lexington, N.C. To contact Glasscoe for speaking or consulting, call (336) 472-3515, fax (336) 472-5567, or email dglasscoe@ Visit her Web site at