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Behavior Management

Back in the 80's "behavior management" was taught in pediatric dental residencies because a pediatric dentist was likely to have some children that would not "cooperate", and the dental treatment must get done, so the dentist needed to know how to manage the "uncooperative" child.

People always wonder how I can treat children. "Aren't they always crying and resisting treatment?" So, I'd like to just share a few of my thoughts on how we "manage" children's behaviors in our practice.

First, it's very important to understand what "normal" behavior his for each age group. A two year old crying or resisting a stranger looking in their mouth is normal. A fearful 5 year old that has been hurt or mistreated by a previous healthcare provider is normal. Children that have had unpleasant experiences in a dental office are obviously hesitant in a new office assuming that all dentists are alike. This is one of the main reasons that I say I don't like to treat "strangers." Trust must be built between a child and the dentist, and knowing how to do that at various ages is the most important thing with "behavior management", and that comes with years of experience. To try and manage a child's behavior in the chair during treatment when trust has not been fully developed is a recipe for disaster in my book!

So in our office we always start slowly with very young patients. I never force treatment on them at ages 2-3. If they have extensive treatment that needs to be done I will usually refer them to a dentist that can treat them under some form of sedation. Holding a child down in the chair or strapping them in a velcro "sleeping bag" is not an option in our office. Another technique we learned in school is called "hand-over-mouth." A young child that is screaming and not listening to what the dentist is saying is quieted by the dentist placing his hand over their mouth to quiet them so he can get their attention and talk with them. We stopped using this back in the 80's.

If treatment is needed, I will always try to do the easiest or quickest ones first to gain the child's trust and show them how easy treatment can be. Once trust has been developed, then the more difficult procedures can be done usually without any resistance. When a dentist understands the child's emotional make-up and introduces procedures at their acceptance rate, I have found there is very little need for traditional "behavior management." This approach to children's dental treatment is always easier on the child, the parent, and the pediatric dentist!

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