Treating pediatric patients can be challenging, but it helps if you use a few child-friendly techniques
By Sarah Lawrence, RDH
As we all know, dealing with children in a dental office can be tricky. Sometimes they are crying, scared, or generally don’t know what to expect in the dental setting. Everything is new to the child—the sights, sounds, and even the smells. Not only are children nervous, but they might be accompanied by an anxious parent, which can make managing the patient even more challenging. But by implementing a few tricks, you will be on your way to creating a positive dental experience for your youngest patients.
First impressions matter
When you first meet your pediatric patient, you must keep in mind that you have one chance to make a positive first impression. Getting down to your patient’s level, making eye contact, and offering a big smile can do wonders for a child’s mood. Imagine being in your patient’s shoes: a new place, new people, new sounds, and being greeted by someone who is two to three times your size can definitely be intimidating to a child.
Another thing that often helps lighten the mood is to comment on something your patients have brought in with them. Younger kids may have a toy or stuffed animal they brought with them from home.
Introduce yourself to their favorite toy and let them know that you might even be able to count the number of teeth that their teddy bear (or another stuffed animal) has! This helps children relax, and then they will usually get excited at the possibility of looking at their special stuffed animal instead of focusing on their fears. If they didn’t bring a special toy, see if you can find a character on their shirt, sparkles on their shoes, or perhaps a pretty necklace they are wearing. Find something to comment on that will make them feel special and show them that you are paying attention to them.
Sometimes, one of the mistakes that we make as busy hygienists with full schedules is starting to “get down to business” too quickly. It’s tempting to want to start talking about oral hygiene as soon as your patients arrive.
After all, we are on a tight schedule! When dealing with children, though, you have to change your mindset. You are there to create a positive dental experience for the child. Children know nothing about staying on schedule. They will do what they want, when they want. It won’t matter if your next patient will be there in five minutes or if you are already 30 minutes behind. Take your time, try to have a relaxed demeanor, and remember to have fun. Your patient will notice any stress signals that you are giving off and will possibly internalize them.
Nobody likes to be told what to do, especially children. If you’re trying to win children over, giving them options is one way to do it. Do they want to use a spin brush (prophy angle) or a regular, manual toothbrush? Which type of toothpaste flavor: bubblegum or mint? Which color of floss stick? By giving choices, children feel like they have more control and are more likely to comply. It’s important to be friendly, yet firm, when giving choices. Children are great at trying to come up with every excuse as to why you shouldn’t floss their teeth. Be prepared for the negotiation.
Taking radiographs on children can be challenging. They gag; they’re scared of swallowing the films; and they don’t know what to expect. Sometimes as soon as children know that it’s time to take radiographs—or “pictures of their teeth”—their behavior starts to take a turn for the worse and they are close to calling it quits before they even sit in the chair. When dealing with a child who is on the verge of giving up, let your patient know that it is completely up to him or her whether to take the radiograph. Let the child know that you would really like to be able to check for “sugar bugs” between the teeth, but that you aren’t going to push or “make” him or her do it. However, emphasize the fact that you would really appreciate him or her being your big helper and would really like it if he or she could help get their “picture” taken.
It’s a good idea to have some small, extra prizes in the area where radiographs are taken to offer as a special prize for a job well done. You can say, “I would really like to be able to give you this special prize, but it’s going to be up to you. Would you like an extra prize today?” Most children are not going to turn down a special prize. Now, the child is the one in control of the situation, and this can help put him or her at ease. The child has been given the choice of whether or not to proceed. If children have decided they want an extra prize, they will start to give their very best and will get their radiographs taken. If they feel like they are being forced to do something they aren’t comfortable with, they usually aren’t going to comply. Some children give all that they have and are still unable to take diagnostic films. If you feel like your patient has truly tried as hard as he or she could, giving an extra prize may still be appropriate.
Obviously, this situation only applies to children who have no dental emergencies that need to be evaluated. If a child presents with pain, facial swelling, or another possible dental emergency, radiographs will need to be taken under any circumstance.
Tell, show, do
Letting children know what you have planned for the appointment helps them anticipate what might come next. Utilizing this approach helps ease the anxiety associated with the unknown.
For example, this is how the “tell, show, do” approach can be used to introduce the mirror and explorer:
1. Tell the child what you will be doing. Give the child a chance to process and ask any questions he or she might have about what you are explaining. You can say, “I’m going to introduce you to my helpers: the mirror and the tooth counter (explorer).” Once the child knows what you are going to do, there are no surprises.
2. Show the child what you will be doing. If you’re going to be using the “tooth counter,” show the child on his or her hand by counting each finger. This is where it would be appropriate to use the explorer to see if you can count the child’s teddy bear’s teeth. Of course, you will not actually touch the teddy bear with the instrument; just keep the explorer near the mouth and start to count. Once the child realizes that you won’t hurt him or her, you have begun the process of earning that child’s trust.
3. Do it. By starting at the beginning with telling the child and then showing the child, your young patient now trusts you enough to allow you to actually do what you have explained. You have taken away any questions that the child has had about the new task, and now the child can start to relax and begin to trust you.
How many times have you heard the phrase, “You catch more flies with honey than vinegar”? The same concept applies to children in the dental chair. Children will respond more favorably to praise than nagging.
When children are doing something that you have asked of them, it’s important to show them your appreciation. It’s also helpful to be specific in your praise, since they may not know that they are being helpful to you or what it is that they are doing “right.” You can say things such as, “Great job keeping your hands on your tummy like I asked you to.” “Thank you for sitting so still while I brush your teeth.” “Wow! You sure are a great helper by keeping your mouth open wide!” Kids love to be praised and to feel like they are being helpful.
If a child is not doing well, try switching gears to something he or she already did well and continue to give praise for that. This may mean that you have to go back and brush with the manual toothbrush for a few minutes. Continuing to push a child into doing something that he or she is clearly not ready for is only asking for more stress to be added to the situation.
As most people know, children are naturally unpredictable. And it’s no different when they step into a dental office. Some children need more time to warm up to the idea of letting someone, particularly a stranger, look into their mouth. When dealing with a child who is showing some signs of hesitation, consider changing the way you approach the situation.
Not every child who comes into the office is going to be willing to climb right into the dental chair and “open wide like an alligator.” With some children, it might take multiple appointments to get them into the dental chair.
If the child is too anxious and won’t sit in the dental chair, you can ask the parent to hold the child in their lap while you continue the appointment. Start off by having the parent brush the child’s teeth “just like they do at home.” The child is much more likely to allow the parent to brush his or her teeth than the dental hygienist. Once the child realizes that it’s only Mom brushing his or her teeth, the child will usually start to relax.
Then, you can simply ask the child, “Can we work as a team? You can go first, and then it will be my turn to brush your teeth.” Because children are usually eager to please, they will often become excited to share with you. This approach can continue throughout the appointment. Remember to use the “tell, show, do” method with any new procedures or items that you introduce. Don’t assume your patients have been exposed to the tools that are familiar to you.
Counting to 10
This technique has worked many times when dealing with children during procedures that can be uncomfortable for them. Children can handle some discomfort if they know it will soon be over. When giving local anesthetic, children will sometimes experience discomfort. In order to keep young patients from getting upset and everything falling apart, just let them know that you will count to 10 and then you will be done.
Most of the time, by giving them praise during the time you are counting, it is possible to make it through the procedure without complications. Another idea is to try to involve the patient. Say something like this: “Can we work together as a team?” Let the older kids count to 10 with you by using their fingers. Then, they will be actively involved in the process and it will help distract them from the procedure.
The most important thing to remember during the counting technique is never to go past 10 (or whatever number you’ve decided on) if you have promised to stop. If you do, children will not trust what you tell them from that point on. Remember, you’re trying to build a long-term relationship with these children, and trust is a crucial part of it. If you have more work to do after you have counted to 10, ask for their permission to do another set of counting. Obtaining their permission will do wonders for their cooperation.
Most children want to be helpful and want to please others. Try not to push the child too far during one visit. If they don’t do well, try to move to another task and not focus too much negative energy on whatever was causing the child discomfort.
By offering gentle reminders throughout the appointment that the child is there to have fun, explaining that there will be no surprises, and letting your patient have some control over the situation, you will help alleviate a bit of the stress that comes from children’s dental appointments. You must remember that you are looking for progress—not perfection—when it comes to the pediatric patient. The first visit the child has may not be very productive in terms of getting procedures or treatment done. Each visit the child has with the dental office is another chance to build the relationship that is so important in pediatric dentistry.
Keep in mind that you are building a relationship with the child and treating him or her as a whole person, not just taking care of the patient’s oral health. Some of the goals in pediatric dentistry are to provide a safe and comfortable dental environment, a place where children look forward to coming and a place that they can be excited about! As tempting as it may be to want to continue to push the child to get something done, you must keep the overall goals in mind. By investing your patience, time, and care into the children, you will be amazed by the progress that can be made in such a short amount of time.
Sarah Lawrence, RDH, has been a clinical dental hygienist for more than 10 years. She currently works in a pediatric dental office and is also a clinical representative for Young Dental and co-host of the Molar Report. In addition to dental hygiene, she practices orofacial myology in the pediatric setting. While her interests are researching and writing, she hopes to branch out into professional speaking to help inspire and educate others. She can be reached via email at sarahlawrencerdh@gmail.