Working with young patients requires a different set of skills than working with adults, they are likely to be anxious about seeing the dentist and quite often they feel reassured by the presence of the dental nurse. When it comes down to treating children the dental nurses role encompasses patient management but also parent management. They may have questions or have concerns about how their child may behave or react during the dental visit. By keeping them informed and reassured they too are much more relaxed. Dental nurses need to be able to pull all of these skills out when needed, this is essential for a successful dental experience.
What dental nurses can expect?
Distraction:
Being in a new environment with lots of equipment around, such a dental surgery, can be a terrifying place for many children, but also an exciting new sensory experience. They will be curious to scan the area around them from the moment they enter the room and throughout their visit. You might start discussing something with them and they will get distracted by an object near to you, this is all normal and you may be familiar with this if you have children yourself or have spent time around young children. In this situation, it's best to give them time and slowly try to bring them back to the discussion. Using coloured charts or audio resources when showing them how to care for their teeth instead of physically trying to have a conversation with them might help you and help you to avoid losing their attention.
Lack of interest or compliance:
Sometimes they may zone out of the moment and that is also okay, every child deals differently with their own emotions. They may refuse to listen and follow simple instructions given; in this situation, you should show them understanding and patience and allow them some time to process what it is that is happening. Most of the time, they are simply feeling overwhelmed and afraid of feeling pain and will refuse anything that comes from you or the dentist as you are unfamiliar to them.
Short attention span
Many children have short attention spans, there are various reasons for this, young age, disinterest or conditions like autism, ADHD or intellectual disabilities. Children are therefore likely to only be able to take in very little information. Therefore keeping your communication simple, using short instructions and giving breaks may help. To help keep your young patient engaged, you can try getting them involved, for example giving them a toothbrush to practice their brushing technique on a tooth model can boost interest and get their attention.
Playful behaviour
As the dental surgery will be a new and exciting environment for them, they may want to touch everything. It is vitally important that equipment isn't left out as this could cause harm and of course contamination may occur. Whilst they may be tempted to touch the dental chair and push all the buttons, simply explain that this is not safe. Other playful behaviour that I've heard about includes biting fingers of the dentist or the nurse and spitting dental equipment like cotton rolls out.
Classifying the behaviour of children
The British Society of Paediatric Dentistry present four ways in which the behaviour of a child can be described:
- Cooperative
- Potential cooperative
- Potentially cooperative (preferred over the old uncooperative term)
- Pre-cooperative: very young children whose cooperation ability cannot be established and children with disabilities.
What are the causes to anxiety in children?
Medical history - some patients may have or had medical conditions and previous medical experience that can inflict a fear for dental care too.
Previous dental history - first experience at the dentist is very important as it sets the developing attitudes of the patient towards dentistry. An unpleasant dental experience can have long lasting effects and deter patient from seeing another dentist.
Parents anxiety - if parents are also anxious in the dental environment, children may be able to pick this up and imitate their behaviours.
Parental presence - studies have shown that your child behaves better if the mother is present, whilst for those older than four the presence or absence of their parents did not affect their behaviour.
Behaviour of the dental staff - children as adults are able to pick up on non-verbal cues. Therefore smiling, being welcoming and respectful of the patient will increase their trust and reduce anxiety.
Awareness of cognitive development
Understandably, children develop at different rates. Piaget’s theory of cognitive development describes the four different stages of learning in children. These are:
- Sensorimotor stage: birth to 2 years - during this stage the infant focuses on physical sensations (like touching objects with their hands or their mouth) and learn how to coordinate their body.
- Preoperational stage: 2 to 7years - they learn to how make a word or an object. They like to externalise their thoughts and can only focus on one aspect of the situation at one time.
- Concrete operational stage: 7 to 11 years - at this stage children develop organised and rational thinking. Here they develop the ability to understand how other people view and experience the world.
- Formal operational stage: 12 years older and above. - children learn to use deductive reasoning and can understand abstract ideas.
Understanding basic aspects of cognitive develop can help us adjust our communication and patient care skills to the type of children that we are caring for. For example, whilst for a child aged 8 years old it might be appropriate show leaflets and diagrams to help them understand how to brush their teeth this may not be appropriate for a five year old.
What skills and qualities dental nurses should have?
- Patience
- Kindness
- Good Communication Skills
These above are key within dentistry and even more so with child patients. You want to create a really positive experience from start to finish. This is very important from a young age to help them with their dental health through the years.
Behaviour management techniques
Tell-show-do - This technique is widely used in paediatric dentistry, firstly, you tell the patient what you’re going to do. This introduces the patient to the treatment and what to expect. The show step involves taking out the object that you will use and demonstrating its use on a model. And lastly, the do stage whereby you complete the task/treatment. I
Enhancing control - This technique allows patients to have more control through the procedure. A patient would be encouraged to raise their hand when they wish for the treatment to stop. It creates a trusted relationship between the patient and the dental professional.
Behaviour shaping and positive reinforcement - This technique uses praise whereby the patient is rewarded after desired behaviour. This might be in the form of badges or stickers or balloons.
Distraction - Playing cartoons during dental treatments is also used to prevent disruptive behaviour. This can also reduce anxiety in children.