A child 3 to 5 years of age has two primary and somewhat conflicting needs (Fig. 57-4). First, the child has gone through a process of developing autonomy and initiative. Second, the child requires control and structure in his or her environment. Children are able to follow simple instructions, and they welcome having an active role in the treatment experience. The child’s role is to help by following directions and “sitting still,” “keeping your hands by your side,” and “opening your mouth wide.” By allowing the child to have choices, the dental team shows regard for the child’s need for autonomy and initiative.

From age 12 to 20, young people acquire self-certainty (Fig. 57-5). They experiment with different roles. Clear sexual identity is established. The adolescent will seek leadership (someone to inspire them) and will gradually develop a set of ideals.

The development of trust between the parent/child and the dentist serves as the basis for a productive, effective means of providing dental healthcare. Dental procedures can be accomplished for patients of all ages if the dental team practices the following procedural guidelines:

In certain cases, some form of restraint may be required for the patient’s protection. A restraint can be physical or pharmacologic, to help keep a patient’s movement or activity to a minimum. If the dentist knows that restraint will be needed, premedication can be prescribed to calm and ease the patient before treatment. Mild sedation, such as nitrous oxide/oxygen or a sedative, may benefit an anxious child. If a child is especially fearful or requires extensive treatment, other sedative techniques or general anesthesia may be recommended (see Chapter 37).

Physical restraint can be as simple as the dentist or assistant holding a child’s hands during treatment. By holding the child’s hands, you can prevent possible injury to the child, the dentist, and yourself, if, for instance, the child were to quickly reach for the syringe during an injection or for the dentist’s arm while using the handpiece.

For young toddlers and preschool-age children, a parent may be asked to help keep the child calm and under control. A problem with this scenario is that if a parent is anxious or nervous about the child’s care, bringing him or her back into the clinical setting may actually impair the situation and create an even more nervous environment.

Additional steps for restraining a child can be taken with the use of a papoose board. This device gently “hugs” or wraps around the child’s arms, legs, and middle section during a procedure. The papoose board uses Velcro straps that fasten over the child and restrains the movement of the child’s hands, arms, and legs (Fig. 57-6). This device is excellent for the younger child who has been sedated, or for the patient with special needs who may have limited control of his or her movement.

When the dentist takes steps in using pharmacologic or physical restraint with a child, the parents must be made aware and must provide consent. An immediate and documented explanation should be given to parents as to why such actions are to be taken. The child should also be informed appropriately.