OPS 2
Child Management
- The vast majority of children coming from the dental office
for
corrective care can be classified as good patients.
- It is equally true that most children enter the office with some
apprehension and fear but that, as clinical experience shows,
they can control this fear by rationalization.
“Problem children are children with problems.”
Illingsworth
- Fears instilled at home or because of parental attitudes, will
not or cannot conform to the discipline and discomfort
attendant upon dental routine.
- One will have more enduring success in handling the patient if
he attempts to recognize these problems and adjust his
psychological approach with reference to his knowledge.
Child behavior may fluctuate over rather narrow ranges
of time.
2 years of age Cooperative and well behaved
2 ½ years of Contrary and difficult
age
3 years of age Amiable, has good control of himself
4 or 4 ½ years Dogmatic and difficult to control
of age
Child Management in the Dental Office
- A child’s uncooperative behavior in the dental office is
motivated generally by a desire to avoid unpleasantness and
pain and what might be interpreted by him as a threat to his
well-being.
- Since children act on impulse, fear of pain may manifest itself
in untoward behavior regardless of rationalization and
knowledge that there is little reason to be frightened.
- Inspite of the child’s desire to please, he finds complacency
untenable in the presence of the unbearable fear of pain.
- This attitude is sometimes difficult for the dentist to
understand, and is sometimes also the difficult for the child
himself to manage his behavior.
- Since fear comes from a lower brain level than reason, it is
quite undesirable that fear is manifested more on an emotional
basis than on an intellectual one and therefore cannot be
interpreted on the basis of reason alone
- Although the child’s behavior may not be well understood and
may seem unreasonable, it is completely purposive and is
based on experiences acquired both subjectively and
objectively during the child’s lifetime.
- His logic is based entirely on his feelings.
- It is the total conditioning of the child which will govern his
emotional behavior in the dental office.
- The child will behave in the dental office in a manner which in
the past has given him the greatest freedom from
unpleasantness.
- If unpleasantness can be avoided at home by negativism and
temper tantrums, he will attempt to act the same way in the
dental office.
- If by forcibly resisting his parents he has had his desires
gratified, then he will attempt to avoid dental work by the
same means.
- A child’s behavior is modifiable. If instances are made
unprofitable to him, his behavior will change.
- One cannot bargain with a young child about behavior
problems.
- It is better in these situations to be a benevolent authority
than to give him his own choice of action.
- With proper handling in the dental office, it is impossible not
to obtain cooperation from the child.
- A great deal depends on how the dentist impresses the child
and how he gains his complete confidence.
- Once rapport has been established, corrective work should
proceed without undue delay.
- A child’s feelings cannot be ambivalent or uncertain
- Therefore, if one is dealing with a frightened and fearful
child, one must first eliminate fear and then substitute delight
and a liking for the dentist.
- The dentist should establish a good relation with the patient
before separating the child from the parent, for otherwise the
child may feel that you are forcing him to abandon his parent.
- The fear of abandonment is critical to a young child.
Hypothetical Case
- The child is brought to the dental office at a young age with
necessary dental work to be done.
- He begins to cry – sometimes with considerable volume –
when seated on the dental chair.
- The dentist, somewhat bewildered and not knowing how to
cope with the situation, dismisses the child with an
apologetic suggestion to the mother to bring back the child
back when he was a little older.
- In six moths the child returns and there is a repetition of the
first visit with the same behavior pattern.
- The child’s fears and resultant behavior have not improved.
His fear of dentistry may have intensified as a vivid
imagination exaggerates the basic need for flight.
- Postponement of a situation such as this might go on
indefinitely with dire consequences to his teeth.
- With the development of aching teeth the pain may lead to
establishment of a true phobia for dentistry
If the dentist had used a more positive approach during the
first appointment, this unnecessary delay and neglect of teeth
would not have occurred.
- In this instance the patient’s fear increases with the dentist’s
fear of handling him, for the cautious child reason for the
delay.
- Any unexplained reason promotes fear in children. Do not
wait for a child to grow an undesirable response; it may take
years.
- Although procrastination is undesirable, a visit to the dental
office previous to the dental treatment is desirable.
- A visit to the dentist before treatment is started might render
the unfamiliar more familiar and migrate any future need for
fear and flight.

- This method works well with preschool children and less with
older ones.
- Although a preliminary trip to the dentist has a value,
continued repetition may not increase the effectiveness of the
procedure unless some actual dental work is undertaken
- The use of derisive and scornful attitude toward the child in
order to shame him into good office behavior is
contraindicated.
- Although many practicing dentists employ ridicule in an
attempt to improve office behavior, it is a waste of time and
has a little value.
- The method is not only inadequate but fraught with danger
when applied to children
- Children do not like being different and desire to conform
to a social pattern.
- Children like to do things other children or persons do.
- They enjoy participation on a competitive basis
- If the child is allowed to watch the dental work being done on
others it will serve as a challenge to him.
- Observing an older sibling or parent in a chair instills more
confidence than does watching stranger but may have little
effect, as stated by Ghose and associated on children under 3
years of age.
- If the child sees the work being done without evident pain, he
will frequently be willing and even anxious to have the same
dental procedures repeated on himself.
- Quite often he will jump into the dental chair without being
asked to do so.
- In this enthusiasm lies a danger.
- If he observes no expression of discomfort on the person
preceding him but discovers, to his surprise, that he is being
hurt when he sits in the chair, his enthusiasm may turn to
disillusionment and he may completely lose confidence in the
dentist.
- It is difficult to rewin the confidence of a child hurt in this
manner.
- If the operative procedure is to be the least bit painful it is
better to forewarn the child and maintain his confidence than
to let him think that he has been deceived.
- To attempt to talk a child out of his fears without giving him
any concrete evidence of why he should not be frightened is
not very effective.
- Since fears develop on an emotional level, verbal appeal on an
intellectual level is generally ineffective.
- Once the child is in actual contact with the fear-provoking
situation, verbal appeal is useless.
- To tell a child he has no right to feel as he does.
- In a fearful situation the desire for flight takes precedence
over reason, and verbal assurances usually fall on deaf ears.
- Don’t expend energy telling the patient he should not be
afraid without first giving him reason to believe so.
Child Management: Techniques in Reconditioning
- By reconditioning through guidance from the dentist, the
child learns to accept and to enjoy dental procedures. He
OPS 2
loses his fear of dentistry because he learns that the
unfamiliar holds no danger to his security. Through
empathy and tact good rapport is established and operative
procedures become pleasant interludes anticipated with
pleasure by both the child and the dentist.
Steps in Reconditioning
1st Step Determine if the child has undue fear of
dentistry
and if so, the reason for it.
This can be discovered by questioning the
parents about their own feelings toward
dentistry, their parental attitudes and by closely
observing the child. Once the cause of fear is
known, controlling it becomes a much easier
procedure.
2nd Step Familiarize the child with the dental treatment
room and all its equipment without producing
undue alarm. By this means the child’ s
confidence is gained, and fear is changed to
curiosity and cooperation.
Most children can be approached by arousing
their curiosity. All children are gadgeteers. Any
new equipment or mechanism interest and even
delights them.
3rd Step Gain his complete confidence. By carefully
choosing words and ideas for conversation, an
understanding can be reached without much loss
of time. When establishing confidence the
dentist must convey to the child the idea that he
is sympathetic and familiar with his problems. In
establishing rapport the conversation should be
directed away from emotional problems and
toward objects familiar to the child.
- During this first appointment only minor and painless
procedures should be done. A history is obtained.
Toothbrush instruction is given. The patient is informed
that his teeth are going to be brushed with the little rubber
cup. The teeth are cleaned and a fluoride solution is
painted on them. Roentgenograms can then be taken. If the
child is first permitted to touch and feel the machine and if
its function is explained, there should be very little
difficulty.
- The x-ray unit can be described as a large camera and the
small film as the place where the picture will appear.
When the child sees the developed x-rays, it will give him
pride in his achievement. It is good to practice to work
from the simpler operation to the more complex unless
emergency treatment is necessary.
The appearance of the Dental Office
- Since the child may enter the dental office with some fear,
the first objective of the dentist should be put to put the
child at ease and make him realize that his experience is
not unusual. If the practice is not limited to children an
effective method of inducing this feeling is by making the

waiting room similar in many respects to his own home
environment.
Want big impact?
- Use the operating room may be made more appealing to the
child if a few pictures on the wall are suggestive of
children at play. A portrait of a carefree and laughing
child is always good. Have the assistant skilled in making
animals or other objects out of cotton rolls. These prove
very amusing to children.
- Try to avoid having child patients see adults in pain or in sight
of blood on others. Person with eyes reddened from
crying, or emotionally upset patients, will unnerve
children. Prevent children from seeing these patients by
having them leave through another door if possible or by
scheduling children’s appointments all at one of day.
The personality of the Dentist and his Ancillary Help
- It is very important the confidence be instilled in the child by
everyone he meets in the office. This applies to the office
assistant, the receptionist and dental hygienist as well as
the dentist himself.
- When first approaching a new child patient always call him by
his first name. If this is not known, ask him what his name
is. Never call him “young fellow” or some other
unfamiliar name.
- If the dentist has confidence in himself, a little of this feeling is
sure to spill over the patient. If the dentist lacks
confidence, it will be reflected in the child’s behavior.
- There is no mysterious formula or secret approach to child
management. Successful handling of children is based on
knowledge, common sense and experience.
Child Management
The time and length and appointment
- In dealing with children, both the four of the day and
length of each appointment are important.
- Both may affect the child’s behavior.
- Whenever possible children should not be kept in the chair
for periods longer than half an hour. With longer
appointments, children may be less cooperative toward the
end of the period.
- Preschool children should be given appointments during
the regular nap time.
o Sleepy, irritable and difficult to manage
o Cry easily and have reduced ability to
cooperate and tolerate discomfort.
The time and length of appointment
- Children should not be brought to the dentist soon after
emotional experience, such as the birth of a brother or
sister or the death of someone else.
- The child at these times is experiencing emotional trauma
and the dental appointment will only add to his anxieties
and bewilderment. At these time cooperating may be
difficult to secure and emotional difficulties are likely to be
encountered.
The Dentist’s Conversation
OPS 2
- In talking to a child the dentist must get down to the
patient’s own level in position and in conversation, in both
words and ideas.
- It is of little values to use words too difficult for the child
to comprehend.
Knowledge about the Patient
- It is a wise policy to know the child patient before he is
seated in the chair.
- When the parent first phones to make the appointment,
pertinent information can be obtained about the child.
- Ask the parent the following question what the child
knows about the dentist and dental procedure.
o Does the child fear going to the dentist?
o Is the child nervous?
o Does he get along well with adults?
o Has he spent any time in a hospital?
o Is he afraid to the physician
Attention to the patient
- Every child should have the dentist’s undivided attention.
- Always treat the child as he were the only patient seen that
day
- Never leave them alone in the chair, for his fears, not yet
completely magnified.
- Do all the work necessary on the child in the same room.
The dentist’s skill and speed
- The dentist should perform his duties with dexterity,
dispatch and a minimum of pain.
- In working with children an assistant is valuable asset.
- She can be invaluable in helping to control the child and in
making operative procedures easer for the dentist.
The use of fear- promoting words
- Avoid using words that might arouse fear in the child.
- Many suggestive fears are not of the procedure itself, but
rather of the fear producing connotation of a word.
- Deception should be avoided in working with children, yet
descriptive words without the connotation of pain should
be used when possible, words familiar to them and used in
everyday conversation.
- Instead of words like “injection”, “needle”, “stick”, etc one
might say “We are going to put something on your gums
that will fell like a mosquito bite.
- Let the child know when he is a good patient, and it will
set a goal for his future behavior. He will try his best to
live up to the standard he has established for himself.
- In praising the child, praise the behavior rather than the
individual. For example, rather than he is a good boy, state
he behaved very well in the chair.
- Gifts make fine rewards. It is good child management to
give the child some gift after good behavior.
Bribery the Patient
- One can state categorically: never bribe a child.
- Bribery will rarely accomplish any good
- The result will simply that the child will keep on behaving
Badly in order to get more bribes and concessions.
- Bribery is an admission that the dentist does not know how

to handle the situation
- A bribe is promised or given to induce good behavior. A
reward is recognition of good behavior after completion of
the operation, without any previously implied promise.
Commands versus suggestions
OPS 2
- Without proper patient cooperation dental procedure
become difficult if not impossible.
- There are many methods of increasing patient cooperation
and in decreasing discomfort such as sedative, analgesics,
hypnosis, tranquilizers and general anesthesia.

- Secure patient cooperation

- When ordering a child to comply with your wishes, state
your wishes in a pleasant yet determined way.
- Do not hesitate to smile and enjoy your patient, yet be firm
if the situation demands.

Reasonableness of the dentist

- In dealing with children be realistic and reasonable.
- Do not condemn a child because he is frightened.
- Try to put yourself in the child’s place and understand
why he behaves as he does.
- The child’s ego will permit him to adjust to stress.
- Treat him as an individual with feeling and emotions and
not as an inanimate object in the chair.

The dentist’s self control

- A dentist should never lose his temper and become angry.
Like fear, anger is a primitive and immature emotional
response.
- It is a mark of defeat and an indication to the child that
he has succeeded tin undermining your dignity.
- Anger lessens your ability to rationalize clearly make the
proper responses.
- If you can’t help becoming angry, it is better to dismiss
the child and let some other dentist test his ability.
- If the dentist has tried to the best of his ability and can’t
reach the child, it is better to admit defeat than ruin the
child for all future dental work.

Gracefulness of the dentist

- In carrying out dental procedures it is well to remember
that young children become frightened at
the unexpected. All your motions, both in handling the
patients and in operative procedures , should be
smooth and graceful.
- Quick and jerky movements tend to create fear in the
very young.
- Don’t drop the child suddenly or tip him back in the chair so
rapidly that he has the sensation of falling.
- In giving an injection, as an example, do not bring the
syringe to the mouth so rapidly that the act in itself
frightens the child. The syringe should be raised in a casual
but deliberate manner.

Be natural and graceful in all your actions and a great deal of

unnecessary fright can be avoided.

- In subjecting children to dentistry one must always weigh

the possibility of psychological trauma against the
necessity of treatment.
- Since dentistry is needed by almost every child, it is
imperative that the psychological trauma produced be
minimal.