Tricks of the pediatric trade and those youngsters
By Judith M. Stein, RDH
Imagine this. You enter the waiting room and greet a 7-year-old patient. You’ve worked with this young person and his family for several years. As eye contact is made with everyone, you notice your patient’s head covered with a ball cap that allows only a small peek at his pale complexion. His eyes aren’t quite as sparkly nor is he as lively as you remember. As you gather medical history information from his mom, words such as cancer and chemotherapy treatment jump off the page. By now, I’m certain everyone reading this knows where the scenario is headed.
I don’t believe anyone is ever prepared for those heartbreaking moments of learning a child is living through very challenging circumstances. I certainly wasn’t. As I walked with this young person and his mother to the operatory, my mind raced with thoughts such as, “What am I going to say? What do I talk about? How do I keep myself from crying?”
It wasn’t long before this child, Dalton, became the teacher and I the student. You see, as Mom was trying to brighten the mood, she shared that the family had received a vacation to Disney World from the Make-a-Wish Foundation. This sounded like a safe topic of conversation. So, as I settled Dalton in and reclined the dental chair, I asked, “So, where are you going?” thinking he would say Disney World. Instead, Dalton looked at me and surprisingly said “backwards.” Backwards. What a moment for me! I was projecting out into the next week of Dalton’s young life. I was letting myself worry about the next year of his life and all I really needed to think about was that moment! Right at the moment, my young patient was going backwards in a dental chair, he was well and safe, and that was exactly where I needed to stay with him. He was my teacher, my hero!
I believe our world is full of heroes that teach us every day. Many of them are children. I hope the following gentle suggestions will provide you with tools to more fully navigate in a child’s world. I hope I can help you stay right in the moment with your hero. Chances are your dental practice may experience tremendous growth if you cater to children, comfort them when needed, and coach them with fun. It really is a simple formula. When a child feels connected to your dental practice, you can expect families to connect to you as well. Come join me on this expedition. See if you can relate to or add anything to the following scenarios, suggestions, and tricks of the pediatric trade.
Begin at the beginning
For me, the dental appointment begins in the waiting room. But some young patients may feel like you’re welcoming them into another world when you call their name. There are so many variables that factor into this vital piece of their dental experience. If they have never set foot in a dental office before, you truly are welcoming this child into another world. If they’ve visited your office with a parent or sibling, it’s more like welcoming them back. Whichever the case may be, making eye contact when you greet a young child and their family members means so much. Pay attention to your body language when you say hello to a child. Chances are if you feel peaceful and not rushed, a child will pick up on those cues. I even find leaning myself down to their height, without invading their personal bubble, allows me to connect with young people more easily.
Hopefully, the few extra moments you share in the waiting room will set a positive tone, allowing you to invite the young person to explore your dental world. Keep in mind that if a child wants to come back to the operatory on his or her own, great! If not, I believe you should make room for the parent during the child’s first office visit. This does not need to turn into a battle. Allowing a family member to join you is just being polite. If adaptations need to be made at the following appointments, at least you have set an initial tone of respect with the parent, who may be more likely to heed your advice if there must be separation in the future.
Welcome to my world!
Never underestimate the power of hospitality. If you’ve been successful in communicating a genuine welcome in the waiting room, you’re now ready to explore this new dental world with your patient and their family in your operatory. Have some fun. I allow the young person to help operate the dental chair. We glove up together as we investigate the air/water syringe and suction. We check out the dental light and decide if the child would like to wear sunglasses. We talk about counting their teeth and using my electric toothbrush to “get the germs off their teeth.” For me, all of this happens before the child has even sat in the dental chair, aka “the guest of honor’s chair.” Yes, I do strive to make each child feel special, because they really are. I work toward beginning a lifelong dental relationship that this young person can always tap into. Keeping that goal in mind, I then gauge if I can proceed with specific treatment options.
Hip hip hooray. Xylitol can save the day!
Although we’ve been aware of the benefits from the natural sweetener xylitol for a while, consider incorporating more information into your pediatric routine. I love discussing the advantages of this natural sweetener with families. I believe xylitol’s benefits are very exciting. Several studies published by the Journal of American Dental Association (JADA) provide favorable research results and information. There are many simple ways xylitol can be incorporated into a young person’s diet, and thankfully many organic food stores now carry a variety of these products, such as chewing gum, mints, and suckers. I strongly encourage you to have literature on this topic as well as Internet sites and store locations available. I know I’m more likely to remember an action item when I have something tangible to connect with when I get home. I believe families of young children also appreciate this gesture. I discuss xylitol with expectant moms who may show decay or periodontal challenges. I encourage them to incorporate xylitol into their diets with the hope of lowering their oral bacterial load even before their child is born.
I am completely sold on electric toothbrushes. Yes, I still coach children on how to use a manual toothbrush, but I now include electric toothbrush education as well. If a family can afford to invest in an electric toothbrush, chances are the child will benefit from this purchase. I suggest you cover both possibilities when working with young patients so they feel confident to use either style brush. I try not to be biased, but so many studies are showing improved plaque removal from using electric toothbrushes. I recommend you contact a reliable toothbrush representative and gather information to pass along to your pediatric families. Ask your manufacturer representative for a demo model to show families exactly what to look for when they are ready to purchase an electric toothbrush.
I also promote staying up-to-date with new pediatric items that are available to the public. Whether or not you recommend a particular children’s mouth rinse or color changing toothpaste, it is critical you’re at least aware of these products. Decide if you want to purchase take-home samples of new products or have literature available for parents. Either way, I strongly encourage you to stay up-to-date with new pediatric products.
What’s your goal?
My goal when working with young children, or anyone for that matter, is to help create positive dental experiences and health for the child and family. This is critical. To accomplish this, I believe we need to provide each child with some control during his or her dental visit. When children feel they have some element of control, cooperation flows from that. I’ve never given away the ship, but I’ve always found a way for the child to help steer. For me, I don’t believe that insulting people about their homecare efforts is ever beneficial. Therefore, whatever advice I offer on homecare choices or nutritional discussions, I do with an attitude of unity. “We’re on this journey together” creates a very synergistic environment between you and your patient. Keeping the goal of “creating a positive lifelong dental experience” in mind will help steer your thoughts and actions and ultimately benefit your patient. If the appointment is going smoothly, then I keep on going. If there are struggles, it may be wise to reschedule another appointment when the child is less anxious. Keep the goal of creating a positive dental experience front and center.
Hollywood to the rescue
Forgive me if I’m preaching to the choir, but how many times have you needed to distract a child while doing sealants, administering fluoride, or even polishing teeth? Distraction can become your best friend while working with children, especially during those 20 seconds when the etchant is resting on a child’s tooth during a sealant procedure. You know, those long seconds when your hands, cotton rolls, bite block, and dental instruments are inside a child’s small mouth. You find yourself sitting gingerly on a fence between triggering a gag reflex, saliva contaminating the tooth surface, or the horrible bitter flavor of the etchant spilling onto the child’s tongue. Yes, we’ve all been there.
After you’ve tuned up and perfected your procedural techniques, consider the following suggestions. A possible solution to this scenario would be to use a DVD player. Having an overhead computer monitor in your operatory is ideal. If not, consider purchasing an in-office portable DVD player. Allowing children to pick out a DVD or bring in their own favorite show is a great distraction. This gesture also gives a child some control over his or her dental appointment. I suggest explaining the procedure first to the child and then starting the DVD. This has even helped an anxious hovering parent who may need a distraction too. Careful though, you may find yourself humming a song from the Lion King.
If your operatory is not set up to show DVDs, you may need to dig deep into the comic side of your personality. I try to collect a few simple and appropriate jokes that can be shared with a child to help distract them. I love telling young patients, “Don’t go outside if it’s raining cats and dogs. You might step in a poodle.” It’s a silly joke, but it offers great distraction and a fun segue to other topics. Don’t worry if you totally ruin the joke. The effect will be the same. Distraction!
Don’t forget to close the deal
Take home items are critical, no matter how successful the appointment was or was not. I used to think that a child had to earn a visit to the treasure box. I now realize that each child brings their best to the time you spend together. Praise the positive and reinforce that behavior with a prize. I’ve also found that sending a daily brushing star chart home with the child is an effective home care tool as well. Whatever you were able to accomplish needs to be accentuated. I have also seen patient referrals increase when I take the time to send a cheery card or note to the family following an appointment. Children love mail, especially when they’re praised and encouraged!
Working with children can truly be an adventure, one that is sure to change with every patient, every circumstance, and every appointment. You absolutely can achieve joy and serenity working with young people and their families. If for some reason you still don’t feel comfortable or confident working with children, consider volunteering with young people to gain more life experiences. I guarantee that volunteering will increase your communication skills with children and bless everyone involved. So, begin at the beginning. Have a welcoming spirit. Let xylitol save the day. Be “sold” on adjunct home care items. Let Hollywood come to the rescue, and always maintain the goal “to create lifelong positive dental experiences” with each child you serve. Most importantly, stay right in the moment with your hero. Thanks, Dalton, for being my hero! RDH
Judith M. Stein, RDH, is a 1981 graduate of Kellogg Community College in Battle Creek, Mich. Judy has enjoyed a variety of professional opportunities in her hygiene career, is committed to lifelong learning, and is now employed in private practice. The author is an active volunteer in several professional, community, and faith organizations. She can be reached at [email protected].
1. The Journal of the American Dental Association, Vol 137, No 2, 190-196, 2006 American Dental Association. The use of sorbitol and xylitol sweetened chewing gum in caries control. Available at http://jada.ada.org/content/137/2/190.full
2. The Journal of the American Dental Association, Vol 137, No 2, 190-196, 2006 American Dental Association. Xylitol and maternal transmission of cariogenic bacteria. Available at http://jada.ada.org/content/137/2/190.full
3. The Journal of the American Dental Association. A comparison of the efficacy and safety of an electric and a manual children’s toothbrush. Grossman E, Proski H. JADA 1997; 128; 469-474. Available at http://jada.ada.org/content/128/4/469.full
Past RDH Issues