Saturday, April 21, 2007

Parental Behavior in the Pediatric Dental Office

Isn't it difficult to work on kids? Well, no not really. It's the parents that can cause much of the stress. We as Pediatric Dentists are trained to recognize patterns of behavior and adapt stategies to change or accomidate the behavior in order to accomplish the desired treatment. We see hundreds of kids a week. We see all developmental stages and ages. We see kids in all kinds of moods and with all kinds of personalities. The parents of these patients know their child quite well, but have also developed an interactive dynamic with their child that they often do not realize exists, and that can occasionally hamper our efforts to accomplish what we are trying to do.

An example might be a parent who has an anxious child. Why is the child anxious? Perhaps, because the mother has either said something about her own difficult experiences at the dentist, conveys unspoken anxiety or has actually used words or phrases that increase the child's reactions. See "Pedo Lingo" for more information on how we use language with children. Parents can be "overloving". They react to every sound or word the child expresses. The child who just wants a little extra attention whines a little causing the parent to say something like, "oh, my poor baby." The child has the parent wrapped around his or her little finger.

Another case frequently encountered is the parent wishing to be present during some kind of treatment. Some dentists do not allow parental prescence during treatment at all. By the way, in our office we allow parents into the treatment area. It is often necessary and desirable to communicate treatment needs, and for many children, parental presence is helpful. I like them to see what we are doing. Many times I do prefer, if I am doing an operative procedure (fillings or something like that), for the parent to be to the side or better yet, if they choose, in the reception area. This way the child's full attention is on me and not the parent. In addition, it can make the dentist distracted trying to manage the child AND the parent. Of course, little bitty children, I need the parent there to help. I like them to be present. Older kids, well, I have seen parents holding the hand of their 16 year old teenager during a simple orthodontic appointment. Seems like more and more parents want to be present than in the past. Gets a lot more crowded these days in the operatory. I'd rather have parents back than sitting worring too much in the reception area. If they are back, they can see what is going on and know it's not such a big deal.

Some parents think their presence will help calm an anxious child. Someties it does. Although we allow parents be present during treatment, we sometimes like them to be apart from the immediate discussion and communication between the dentist or assistant and the child. If the parent is hovering and interacting with the child, the communication is just not there with the dentist. It makes it much harder to communicate with the child. Example: Dentist: "Johnny, how old are you?" "He's 7 years old" (Mom answered the question not the child)(by the way, I don't mind a parent answering, this is just an illistration). Or, Dentist speaking: "Johnny, I'm going to put some sleepy juice in your mouth to help your tooth go to sleep". Mom then steps in and says, "You're ok, it's not going to hurt a bit", just squeeze my hand if it hurts." The child then is anxious. Hurts? What is going to hurt? What's going to be ok? It might not be ok??? He has already forgotten what the dentist said. Dentist: "Johnny, open your mouth, please", Johnny looks at mom who's hovering nearby. Mom says, "Johnny open your mouth" Johnny never looks at the dentist. This is going to be tough. You would be surprised how much better many children do once the parent leaves the treatment area (or at least around the corner). It is my observation that if a child is crying and the whole thing just makes a parent's anxiety level too high, it is not unreasonable to consider other options for treatment such as sedation or general ansthesia.

Having said all this, a lot of us parents simply can't help trying to help our children the best we can. Hey, I understand that. So, in summary. Love and support your child, but let your child establish some independance. If you have questions, by all means you are welcome to come back with your child even for the most difficult procedures. However, let the dentist and staff use their skills and training to manage the child and the treatment. They don't need to divert their attentions onto an anxious hovering parent in addition to all the other stuff they are thinking about.


Anonymous said...

Great post. I saw your presentation in San Antonio and look forward to reading more posts. Do you have an written office policy to give to the parents to encourage them to be "silent observers" as I call it. I try to have my staff tell the parent when they are brought to the treatment room but that can be hard to do for each patient. I have considered printing a pamphlet to give to parents whose children are scheduled for treatment. Thoughts?

Dr. Dean Brandon said...

Well, first of all, I'm glad you attended the presentation. I'm hopeful something out of this blog will be of interest.

We did print out a written handout, posted it, put it in new patient packets, etc. I don't know how effective it has been, as it is my observation that parents that 'really' want to come back tend to ignore such recommendations or assume their child is the exception. Our "policy" is obviously flexible and was written very carefully. I'll try and see if I have a word document I can e-mail you(I'm not sure I do), but if not, if you'll write me at our office: 4001 Balmoral Drive, Huntsville, Alabama, 35801, I'll send you a copy of what we use. Really there is no magic solution except communicate as best you can in a caring understanding manner.

Anonymous said...

Because of ignorant dentist like YOU, now are parents like me who cannot find a good descent dentist to take my child to that will allow parents in the room while in treatment. I am a psychologist to be and I advocate that parents presence is A MUST! During any medical and dental care! Parent should NEVER EVER EVER be denied to be present, that is why so much abuse exist during children's care around the nation today. It's not the parent who causes the stress to children, you IGNORANT! It is the men or women in uniform that causes a child's stress. Parents are a great deal of help while they stay in the room with their children, a terrify child will not calm down because the parent is not in the room, the child will relax if parent and preferable BOTH parents are present with the child while in treatment. I don't know where you all get your degree at, but it's very trushy what you are advocating around the nation today, I cannot believe that a PEDIATRIC dentristy will think this way. It's easy for YOU because without the parent's prensence you can do whatever you want or say whatever you want to the child whereas if a parent is present then you have to watch it more, so that STUPID remark about parents make their own children nervous put it right in your "POCKET!" If you know what I mean!

Dr. Dean Brandon said...

Hmmm. Seems the author of the comment above didn't read the whole post. We DO allow parents back with their child ( in our office anyways). Sadly, there seems to be an obvious lack of trust with the dental profession here, (maybe others too).

There probably is nothing I could write that would better confirm my statement in the first two sentences of my post: Isn't it difficult to work on kids? Well, no not really. It's the parents that can cause much of the stress .

Anonymous said...

I strongly agree with Dr. Brandon. I am a mother of three who are patients at APDA and feel that my children are more attenative to what they are told about their dental care and are more well behaved and do answer for themselves if I am not hovering over them. I know that at the end of each visit that I will have my time to talk to the dentist and find out any information needed in the care of my children's teeth. Thank you APDA, we have been patients for over 10 years.

Anonymous said...

I too sort of agree with the other 'anonymous' who explained about not letting parents in the room.I'm not specifically saying about you Dr.Brandon [I read your post].Well there are dentists,assistants & staff out there who really don't behave well especially to young children.I too worked as a dental assistant keeping all these things in mind and sometimes did think some parents are a little nosy.But once I became a mother & had to take my child to a dentist I couldn't stop talking to my child ( a 3 year old) and comforting him.I felt that was really what he needed.I can never leave my screaming child alone with somebody who he thinks are strangers. A well experienced Pedodontist will know what kind of children need their parents in the room regardless their age or the procedure done.

Also I don't think any 'normal' parent would ever tell their children about a bad experience in a dental office.They will only try their best to give positive things about dental treatment & their experiences & ease the anxiety.Parents are parents and they probably cannot stay as "silent observers" when they see their nervous child in the chair.They have to do what they have to .So don't blame them.

I strongly believe parents should be in the room unless it a child who is old enough to say that he/she is 'uncomfortable' when the parent is in the room !

Anonymous said...

I strongly believe that children especially young children should be accommpanied by a parent. I too experienced this in a dentist office but was in turn lied to stating that it was Osha rules and that the radiation would hurt me. There is no chance of me getting pregnant (tubal) so I dont mind stepping out of procedure room for a minute. So many things are happening to children these days. I think parents should be a little more cautious in leaving them in the hands of strangers behind closed doors- down the hall and around the corner. I am a nurse; accidents happen all the time in the medical field. The employees should also be protected against allegiations of abuse. Once there is a trust relationship built, maybe some parents would allow their kids to have procedures done alone. I still think that it is a unsafe practice and very thin line when it comes to small children. Yes, I was told no I couldn't go in but after I explained that I knew my rights on the matter I attended all 3 visits with my 9, 7, and 5 year old children and yes I was a parent in every way.

Anonymous said...

Interesting comments by all. I'm the parent of a seven-year old son who has gone back to the exam room without my presence since he was two and now he has gotten so anxious by his previous visits (only cleanings and one cavity filled), he's scared to go to the dentist. As a parent, you want what is best for your child, and now he's scared to go . . . not for anything I've done or said to him, but because of something done or said to him "in the back" without me. That's why I'm online today seeking out other pediatric dentists to consider, since it is time for a cleaning and he starts crying when I mention it . . .

Anonymous said...

I guess I posted my comment in the wrong post! I appreciate the message you convey with a few points to make.

To me it is common sense parenting to be a "silent observer" as you put it. Just knowing you are in the room can help calm a child.
I have had experience with behavior modification as I am a mom of 2 sons with Autism Spectrum Disorders. Parents have issues they are unaware of sometimes which can make matters more chaotic in the treatment room, I can see that, but not ALL parents are over protective, answering questions for their children and transferring anxiety to their kids. So why make policies for all parents and why not educate parents or communicate. Is it too much to say "In our treatment room, you need to be ...and you can please sit over here, but in order for me to communicate effectively during the treatment, you must be a "silent observer".
Explain to the child Parent will be sitting here and she will be our silent observer..." Talk!

There should never be a policy to refuse parental rights to stay with their child. The excuses these offices give are unbelievable and at times downright lies. it is very wrong.

I would encourage all dental professionals to communicate with all parents. The brochure idea is a much better way of addressing how to behave in the treatment room. Maybe some Dentist could even make an educational video for families to watch before treatments. For the lay person/parent? For the child? Prepare?

I think the effort to change this dangerous and at times anxiety provoking policy in the field of Ped. Dentistry is needed. These policies are a very old school way of dealing with simple issues.
I like the brochure idea. Set a boundary with the parent, so they know how to help their child, if thats really the point this policy makes.

Given a choice between leaving heir child alone for treatment with strangers or respecting helpful boundaries like "silent observing"; I can bet any parent would choose to respect the Treatment Room Rule of "Silent Observing".

And it is win win for everyone.

Dr. Dean Brandon said...

You have some good points and some good ideas.

Anonymous said...

I am a Pediatric Dentist in Private Practice, I also teach at the Post-Graduate level in a Pediatric Dental Residency Program.

I have been educated in my program and we educate at the Hospital to always have the parent in the room, unless the parent knows it would be better without them and elects to sit it out.

Most newly educated Pediatric Dentists are taught this. I find it very helpful to have the parent in the room, they can help hold their child's hand, and restrain them if necessary. For the child it is better for the parent to hold them, because they trust their parent.

It is also helpful for the parent to see what we are doing, explain it to them so they understand why we are doing it,and are on-board with treatment. If their child has a hard time with it, then it is good for them to witness how how it is for us as health care providers to deliver compassionate care to their child.

Every so often I encounter a parent who talks over me. They usually are not trying to undermine me they just don't understand the philosophy. So I explain to them that I need them to stop talking and just be quiet so that their child will focus and listen to me and I tell them that I am not trying to be rude, but that it is a technique that we use. More often than not the parent gets it, and is not offened. I think I have offened only one person, putting it that way. Oh well, you can't make everyone happy.

As an aside, I had to take my daughter to see a Pediatric Neurologist, and I was talking for her, and he had to tell me to be quiet! You think I would have known better, but I really didn't think about it,as a parent we just automatically do it.

Any written policy the office has should also be stated verbally. People don't read them. The key to success in treating children and their parents is good communication.


Anonymous said...

I am a Patient of Alabama Pediatric Dental Associates and I feel very fortunate that there is a dentist place that treats people like me for I have been through Special Ed ya I get a little bit nervious when I am with the person who cleans my teeth but I see other people getting there teeth done to but I do feel better when the Dentist is there Specially Docter Brandon or Docter Lackey some day I would like to be a dentist to.