Promoting positive behaviour among children, adolescents and their caregivers in the dental surgery

This section is a practical guide for specific modes of interacting in the dental environment which can help produce positive and adherent behaviours in child and adolescent patients, as well as their parents and other caregivers (e.g. grandparents). These guidelines are based on principles and research findings from behavioural dentistry, as well as behavioural, developmental, child and paediatric psychology.

It is probably true for most of us that the meaning of our lives is centred on our personal relationships. These are the source of our sense of personal identity; they are the source of our emotional security or insecurity that might define us; they are the source of our greatest joys, of our deepest comforts but, of course, they are also the source of our most bitter disappointments. However, without personal relationships life for most of us would be meaningless. We might dream of escape to the proverbial ‘Desert Island’ but we wouldn’t want to stay there for more than an hour or two or possibly a week, because we would soon realize that the lifeblood of our lives is in our relationships. That is where we get all the rich material for coping with life (Hugh MacKay, ABC radio 26 March 2010). So at home and at work, we need to nurture our relationships constantly. In dentistry, this is particularly relevant, as we are working intimately, not only with those we are caring for, but also with their carers and indeed the entire Dental Team. We spend a great deal of our waking hours ‘at work’, which we want to enjoy as much as possible and so our relationships become crucial and can be used to positively affect the behaviour of the child in the dental environment.

Much has been written about management of problem behaviour among children receiving oral healthcare, with a focus on the use of various techniques. This guide, however, emphasizes specific, simple methods that can be used with children and adolescents to enhance their comfort and cooperation. The general idea is to use finesse instead of trying to achieve absolute behavioural control. Since a sense of lack of control is one of the major components of anxiety and fear (along with a lack of predictability), using methods that are encouraging rather than demanding can go a long way in promoting comfort in the dental environment.

Dentists, dental hygienists and dental therapists are integral members of the healthcare team for children and adolescents and must have an awareness of practical methods of behaviour management that are based on knowledge of psychological principles and stages of growth and development. The adage that ‘children are not small adults’ promotes the idea of special knowledge and behaviours that are important in caring for younger dental patients. Oral health professionals must have a knowledge base in child and adolescent medicine, as well as in social, emotional and cultural factors affecting the health and behaviour of this age group.

It is imperative that dental appointments in infancy, childhood and adolescence are positive, as research clearly shows that early experiences have strong effects on whether dental advice and treatment is sought in adulthood. Having a rapport with the parents/caregivers (e.g. grandparents) is essential, as they typically are the most influential people in the child’s life.

Child behaviour and development

Working with children is, of course, different from working with adults, therefore, it is essential to be familiar with age-appropriate skills and functioning, and development. Infants, children and adolescents are undergoing progressive changes in cognitive, receptive and expressive language, fine and gross motor ability, and social/emotional development. Each child is unique and may develop at varying rates relative to their same-aged peers, For example, one child may present with strong motor skills but less well-developed language, while this may be the opposite for another same-age peer.