Bring out the child in you - to manage a child in dental clinic!

For a successful bi directional communication, all the 4 elements have to be present.

• The dentist needs to use age appropriate vocabulary and body language, which remains consistent throughout the interaction. Children as young as 3 years can sense a smart, dominant and nice individual from non verbal communication. This plays a very important role as we need to portray ourselves not only as nice and smart but also dominant, to gain the child’s attention and co-operation through the procedure.

Dentists are advised to avoid body language that may convey uncertainty ,anxiety or urgency.

Basic behaviour guidance

Communication remains the most important, and plays an vital role in all the modification techniques. From gentle teacher student voice during the tell-show-do technique, to a calm and friendly voice while giving child the instructions like raise your hand to stop the procedure. This helps in building trust with the child, and gives child a sense of control.

Voice modulation between firm and appreciative works very well during voice control.

The various behaviour management techniques we frequently use-

1. Desensitisation :used in children with previous anxieties, the child’s anxiety is dealt with by exposing child to dental experiences in the order of increasing anxiety provocation. To put it simply --- in the first few appointments simpler procedures are done, like check ups, x rays, and sealants to reduce the child cope with anxiety and also helps increasing child’s confidence in handling dental procedures. It has worked very well, when the child’s first appointment is simple, he/she also develops a sense of achievement and we also compliment and gift the child for helping us with successful checkup and we also combine it with introducing the child to drill, by showing them how it works (TSD) which prepares the child for the next appointment.

2. Tell - Show -Do (TSD) : here the procedure is first described in words and phrases to child’s understanding. We believe in using a lot of euphemism here ( for eg water spray instead of drill, vanilla paste instead of restorative material ). Then the procedure is demonstrated in a way that involves appropriate senses and finally performed without any delay .

3. Modelling : child tends to learn from a model of similar age, gender or someone the child looks up to. Modelling has limited usage in the clinical practice.

4. Reinforcement : when a behaviour that follows a stimulus is reinforced, its strengthened and is more likely to recur in similar circumstances. There is positive reinforcement, that’s when, desired behaviour is rewarded with compliments. We give every child who gets treatment done, stickers and balloons and over the years we have realised what a positive impact it has on children and how they remember it for years . Then, there is negative reinforcement. For example I request the parents to wait outside and call them in once the child calms down and agrees to listen. Sometimes what works, best is voice modulation, where a firm loud voices used to gain child’s attention , and once a desirable behaviour is achieved immediately the child is complimented .

5. Voice control: Changes in tone and loudness of speech along with changes in facial expression is what is described as voice control . “Open your mouth and stop crying” in a loud and sharp voice can surprise the child, help the dentist gain the child’s attention and proceed with the procedure. Appropriate use of voice control is known to be very successful in managing children.

6. Memory restructuring : it is a behavioural approach in which memories associated with negative or difficult events are restructured into positive memories .

Restructuring involves 4 components

• visual reminders
• positive reinforcement
• concrete examples to encode sensory details
• sense of accomplishment.

7. Restraints : Restraint in the dental setting is the act of physically limiting the body movements of child in order to facilitate dental procedure and decrease the possible injuries to the child. For younger children , we encourage using lap to lap position, that helps in restraint and also comforts the child as the child is facing the parent. As the child age increases , the child can sit on parents lap and parents can hug the child , which would provide restraint as well as comfort the child . Our dental team also plays a role in gently holding the child’s hand or head to avoid injuries .

Other forms of bodily restraint, wrap and hand over mouth behaviour modification techniques are there, but are not widely used.

8. SADE : sensory adapted dental environment :

It includes adaption of clinical settings to produce calming effect. The objective is to enhance relaxation and avert negative avoidance behaviour .

Conclusion

Understanding child’s mind is no child’s play , the more we understand the more equipped we are to handle the little humans in the dental clinic.