We’ve all been there. Suppose you’re sailing through the day, enjoying the work, the patients, the satisfaction of providing good dentistry. Then you take a look at the schedule and realize the front desk has filled that afternoon hole with a new family.
Quick, what are your first thoughts? I’ll bet they’re the same as mine — how old are the kids? Nothing adds more pressure to a hygienist’s day than the thought of a little one who might scream — might kick — might bite — and might make you feel like the most inadequate health-care worker in the world.
How can you introduce reluctant children to dentistry in a positive, nonthreatening way, and make them happy they came?
M.E.J. Curzon, a well-known writer on pediatric dentistry, makes a broad statement in the British Dental Journal to settle the question once and for all. The objective in managing uncooperative children, Curzon says, is “to identify why the child is difficult and then set out a strategy of psychological management and empathy to enable the child to cope with the situation and come to accept dentistry as a normal and routine way of life.”1
Easy for a researcher to say, isn’t it? No one’s throwing up on his leg.
Here are some real-world ideas to start off on the right foot, balance carefully on that foot, and then escort a smiling, cooperative child back to the waiting room.
The first step: walk in their Stride Rites
As you greet a child, stop thinking about your job, your coworkers, your lunchtime errands, and your son’s science project that’s due tomorrow. Instead, try to put yourself in the child’s head. Will Tyler be apprehensive? Excited? Ready for a fight? Is he afraid it will hurt? Does he have control issues? Is he worried because you’re a stranger? Have some empathy. Here’s what he might be thinking: Who is that? Do I have to go with her? Right NOW? What’s she gonna do? Will it hurt? Oh, no ... oh, no ... OH, NO!
To stop that kind of thinking before it gets a good start, greet Tyler without putting any pressure on him. In the reception room, introduce yourself and let your patient know that you’re not ready to start yet. That’s an immediate signal for relief. Ty can relax, and you can begin building a relationship. After you shake hands with his parent, compliment his shoes, and explain what you’ll be doing that day, tell Tyler you’ll be back for him in two minutes. The two-minute warning is a great tool for defusing a potential meltdown, because it gives the child a breather and lets him know exactly what’s coming up next, and when. Now, when you re-appear, his internal dialogue goes like this: Oh, yeah, she said she’d be back. She’s gonna count my teeth and polish ’em with the electric toothbrush. She said Mommy can stay with me if I’m good. OK, I s’pose.
The second step: tell, show, do
This is familiar advice; we’ve been hearing it for years, but I’ve still seen hygienists ignore it. If you begin to take the job for granted, it’s way too easy to let your eyes glaze over and go through the day on autopilot. If that happens, you might not recognize when a child needs help to understand what’s happening.
Suppose Mikayla, a timid 5-year-old, is in your chair for the first time. She doesn’t know you, and she’s never been in your operatory before. Introduce yourself again, talk about the room, and explain everything in it. “Look at that big white arm on the wall. Did you ever see one before? That’s my special tooth camera. Watch how it moves. See if you can make it turn around. Pretty cool, huh? In a minute I’m going to use the camera to take pictures of your teeth.”
Ask Mikayla if she remembers how we clean her teeth. If she doesn’t, that’s your signal to slow down and offer step-by-very-detailed-step explanations. Never let anything be a surprise. If you have her stand beside the chair as you demonstrate how it moves, that won’t frighten her. If you polish her fingernail, she’ll know how the prophy angle feels, and it will be less intimidating. If you describe the saliva ejector, and let her suction a puddle of water off the palm of your glove, that won’t scare her either. I like to pick up a scaler and rub the broad edge against my gloved finger. “See, Mikayla, I use it on the side of your tooth like this.”
Once you’ve gone through “Tell” and “Show” — two or three times if necessary — don’t hesitate to “Do.” If a child fusses or cringes a little as you start to polish, don’t stop. Ignore the protestations and start anyway. Polish one front tooth, then ask Mikayla if she’s OK. Polish another one, pause, and ask again. Once you’ve gotten a good start, you can usually finish with no trouble.
The third step: use the H-word
Practically the first thing I learned about child management in hygiene school was, “Never say the H-word.” I didn’t say it for my first 25 years of practice. If a nervous parent insisted on repeating, “She’s not gonna hurt you,” I always countered by repeating, “We don’t use that word here.”
Eventually, it dawned on me that the H-word was like an elephant in the room. The child was thinking it. Mom was thinking it. And just because I was ignoring it, that never made the word go away.
So I started using it myself. Every time a child asks, “Is it gonna hurt?” I look him right in the eye and say, “Sage, I will not hurt you. The toothbrush might tickle, but nothing I’m going to do will hurt you. Are you ticklish?”
The fourth step: admit the difficulty
A recare appointment is not easy for children. A relative stranger invades their personal space, manipulates their body, and introduces strong tastes, smells, and textures. Their tongue might get pinched, their lips might get stretched, and their face might get splattered. They might gag. In spite of all that, they’re expected to sit still, be quiet, and put up with a lot.
Think of a polish, for instance, from your own perspective. If the prophy paste is too strong, or too gritty, or too thick, so what? You’re already thinking ahead to the best part — clean, shiny, smooth teeth.
Now imagine it from a child’s perspective. If the prophy paste is too strong, too gritty, or too thick, guess what? That’s all the child can think about. Ewwww, ewww, ewwww, Mommy, it’th on my TO-N-NNGUE!
So admit the difficulty. “That’s OK, Kaden, I know it feels funny and tastes funny, but it won’t hurt your tongue. It’s OK for it to be there. I’ll rinse it off in a minute.”
When an appointment goes on a little too long, tell Kaden you appreciate his patience. “Sweetie, I know this is hard for you. You’re probably real tired of staying open by now, and I know you don’t like the flavors you picked. But you’re trying to be a good boy, and that makes me happy. Look at Mommy. Is she smiling too? She’s proud of you for doing so well.”
The fifth step: let’s all be busy
An unoccupied child is a dangerous child. If you don’t want them playing with your air/water syringe, or touching things they shouldn’t touch, keep them busy. As you step out to develop an X-ray or summon the dentist, hand your little patient a Magna Doodle or a computer game. Get some flash cards and mix them up so you can hand them to a bored 10-year-old. “Could you put these in the right order for me?” They’ll be happy to help.
If you’re twiddling your thumbs waiting for an exam, don’t do it in the lunchroom. Stay with the child and start a guessing game, or quiz them on spelling words like “saliva” and “toothbrush.” Show them their X-rays. Ask about their favorite teacher. Keep notes on the older kids, so you can ask for updates on band concerts or church missions or basketball teams.
The last step: celebrate the visit
In my pedo office, one of the things we overhear on a daily basis is, “Ta-da! You did it!” Whether the visit was easy and carefree, or difficult and fraught with challenges, we celebrate each hurdle with much fanfare. We compliment children on being good spitters, learning to use the suction, picking out a cool toothbrush, holding as still as a statue for an X-ray.
The end of the visit calls for more fanfare. My boss’s favorite closer is “Bye, cutie pie, thanks for being my friend!” Mine is “See you next time. Thanks for being such a good boy!” One of the assistants is fond of “Hey, buddy, you were a great helper today!”
In other words, it can take a lot of time and effort to treat a child successfully. But consider this. If you make a child your friend, and help her understand what you’re doing and why, she’ll be happy to see you next time around. What could be nicer than to hear a mother say, “Olivia loves to come here. She’s been talking about you for six months.” RDH
Cathy Hester Seckman, RDH, has written on dental topics for 26 years. She works in the pediatric office of Jay Reznik, DMD, MS.
1. Curzon MEJ. Book Review: “Child Taming: How to Manage Children in a Dental Practice.” British Dental Journal 2004; 196, 239. Published online Feb. 28, 2004.
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