Management of Children Behavior in Dental Clinic
– The delivery of dental care to a child is almost always dependent on his/her behavior.
Behavior modification is primarily aimed at providing a child quality dental care in a comfortable manner.
– If the child behavior is disruptive, however, the same is not possible.
– The disruptive child behavior results due to a variety of reasons in a dental clinic:
1. The child failing to understand the reason for his/her dental care
2. Fear of either a past negative experience with a doctor/dentist (objective fear) or strange, unknown environment (subjective fear)
3. Experiencing pain or discomfort midway
4. Knowledge that disruptive behavior may result in stoppage of procedure
5. Other temporary reasons such as a bad mood, tiredness, not able to concentrate if hungry, wanting to do something else, etc.
– The child’s parents always make a decision of taking the child to a dentist. A young child may not understand what parents mean by going to a dentist or getting teeth fixed.
– Even though a child is explained about what the dentist may do to his/her teeth at the clinic, the child’s imagination may not be sufficiently developed to give him/her an idea about what would happen in the dental clinic.
– Why should a child want to get the dental treatment done? A child may want to have better looking teeth or pain-free teeth; however, he/she is seldom ready for the dental treatment as such.
– The dentist as well as the parents must instill positive attitude in the child’s mind regarding dental care during initial dental visits.
– The child has to be convinced that the people at the dental office are good persons and are harmless.
– Only then, the reason for his/her dental care such as treatment of decayed teeth could be made apparent to the child.
– The child may look forward to have his/her teeth fixed only if people around him/her at the dental clinic appear before him/her in a friendly manner, praise him/her and also allow him/her certain privileges.
– A child who is not sure of what is going around him/her throws a tantrum just to get rid of it.
– There is an issue that is of concern to the child: Will I get pain? If a past visit is associated
with bad memories of pain, the child now wants to avoid it from the word go.
– An associated fear of this kind may often result in disruptive behavior particularly when the dentist fails to assess and modify child behavior sufficiently prior to starting treatment.
– This type of disruptive behavior comes with a strong objection to all dental care and is
difficult to control.
– It is important to understand the contribution of pain factor along with the fear factor in precipitating disruptive behavior.
– Experiencing pain is the most valid reason a child may have for the disruptive behavior.
– The dentist must concentrate in the initial visits and if possible, always strive to impart pain free dentistry.
– Once a child’s behavior is modified, a slightly painful experience is usually not taken that
negatively; hence procedures requiring the child to bear with pain (such as palatal
infiltration for extractions) are best scheduled after a few successful accomplishments of simpler treatment procedures.
– If the child has experienced that by throwing a tantrum he/she has averted treatment (or any unwanted situation) successfully in the past, this knowledge comes handy to him/her in the dental clinic.
– The attitude of parents and the dentist play an important role in such a circumstance.
– If the child’s disruptive behavior makes the dental team stop the procedure and if he/she is left alone, the child has scored a point and senses victory.
– Now, it would be even more difficult in the subsequent visit to control and modify child
behavior unless a different strategy is implemented.
– A usually cooperative child may also have his/her bad day at school, be feeling sleepy, have not got enough time to play on that day or is simply tired.
– The dental team must respect this and accept the child’ negative response.
– However, the child in such instance should only be subjected to a brief routine of just getting teeth examined and left after that with a promise to cooperate well in the subsequent visit.
– Usually a disruptive behavior manifests with following characteristics:
2. Movements of hands, legs (kicking)
3. Wanting to get down from the dental chair
4. Asking parent to come close, hold hands
5. Desiring to go home
6. Stopping communication, eye contact
7. Solitary talking
8. Angry/hurt facial expressions
– Crying’ is always associated with disruptive behavior.
– The crying of a child can be of various types:
Type of ‘cry’
What should be done
– A loud and continuous crying to create commotion in order to achieve immediate attention and scare others.
– Wait for a minute to see the progress, do not panic.
– Do not allow the child to get down from chair
– Ask the child that only if he/she stops crying, attention will be given to him/her; ignore it for
– Voice control.
– HOM (after informing parents) if everything else fails.
– In most children, it does stop after 2-3 minutes;
– Crying may not be loud or continuous but is associated with withdrawal (child turning face away, suddenly pulling the hand back while demonstrating airway. syringe in TSD, starting to panic on seeing a needle)
– Give a proper TSD demonstration
– Model the procedure
– Comfort and reassure the child Engage the child in a conversation of interest to him/her
– Distract the child
– After experiencing pain; for example, a palatal or intrapulpal administration
– Reassure that the pain is over and shall not be repeated
– Divert attention; for example, ask the child to rinse mouth a couple of times after LA administration
– Offer sympathy
– Tell him/her that he/she was brave to tolerate that much of pain and will be appropriately rewarded
– Continuous, low volume but irritating crying mainly to relieve himself/herself than to protest
– Be prepared to listen to it! (It may not be stoppable in some children) Ignore!
– Don’t discourage when not controllable and does not come in the way of treatment!
– It is important for a dentist to decide how to control the ‘crying’ part of the disruptive
– The dentist must know the ways to tackle crying in order to restore good behavior.
– It is important for a dentist to identify whether the objection on the part of the child is
temporary in nature or a more rigid one.
– The disruptive behavior has to be managed well by a dentist catering to children, but more so, has to be prevented with proper understanding and implementation of behavior
– Disruptive child behavior in a dental office is a ‘crisis’ in child management.
– The dental team must have a proper methodology for this crisis management and not merely start firefighting abruptly.
– The following discussion describes the methodology in a stepwise manner.
1. Let everyone know that the situation is under control; do not shout, panic or give
2. Tell the parents that there is no need to worry if the child is not crying in pain; at times
children cry and they can be confronted with a bit of authority so that unnecessary crying is discouraged. Use voice intonation and if necessary hand-over-mouth only after their
3. Tell parents that only after the child gets a pain-free experience of dental treatment, he/she will realize that there was no reason to cry; however, in order to give him/her such
an experience, at times the dental team has to use stern measures.
4. The parents, if present in the operatory, may be asked to wait outside. At times, a child may be crying to seek attention of his/her parents. Also, once the parent has left, the child has no choice but to listen to the dentist. The child also learns that he cannot dominate the proceedings thereafter.
5. Tell the parents that there exist only two ways of managing children for dental care:
a. By such behavior modification techniques and
b. Under GA in a hospital set-up. (Most parents choose the first!)
1. Wait for a minute to see the progress, do not panic.
2. Do not allow the child to get down from chair; let the assistant restrict the child movements.
3. See to it that the child does not cause an injury to himself or anyone else and does not damage anything.
4. Tell the child that only if he/she stops crying, attention will be given to him/her.
5. You may use a temporary threat but do not leave the child scared.
6. Use a behavior modification technique that has not been attempted till this point. For example: parental separation (send the parent/s out and ask them to come in only after being called in; tell the child that the parent/s would be called in only after he/she stops crying and follows all instructions).
7. Ignore it for a while, once necessary instructions are given. Give the child time to control himself/herself.
8. Use voice intonation.
9. Use HOM if everything else fails after informing parents.
10. Do not stretch it further. Do not feel defeated by the child. Control your anger. Inform parent/s that your best attempts have failed to achieve cooperation; you may give it another try some other day. Ask them that they also need to prepare the child better at home and get him/her back. If the child cooperation is not attained they may have to take the child to another specialist or consider treatment pharmacologically.
– The management of disruptive behavior is a learned skill.
– The efforts often yield positive outcome if the dental team is focused on achieving the result. Also, it is not unusual to see a good behavior at the next visit from the same child who demonstrated disruptive behavior earlier.
– Remember, children do take pride in performing and feel guilty after realizing their mistakes/misconduct.
– If sincere intentions of the dental team have reached the child’s mind, the mind of a child more often than not, responds favorably.