The Childs Voice: Understanding the Contexts of Children and Families Today

Resident’s Name: Brian Schmid DMD Date: 9/11/09
Article title: The Childs Voice: Understanding the Contexts of Children and Families Today
Author(s): Dennis Harper PhD, Donna D’Alessandro MD
Journal: Pediatric Dentistry
Month, Year: 2004
Major topic: Social context of the modern family
Type of Article: Review
Findings: There have been many changes in societal outlook over the last 15 years, all of which may contribute to increased stress both in parents and children. This may lead to decreased compliance in children today, something with which we will have to deal acutely. According to modern medical professionals, discipline has been on the drop and ambivalence on the rise when it comes to modern parenting techniques, the majority of providers think that the change in parenting practice has been negative. Less assertive behavior management techniques have also become more popular due to the changes in parental attitudes.
Accountability has been passed on to mental or physical problems the child may have, as opposed to implementing strict disciplinary guideline in the home. The amount of children being treated for an attention disorder or other psychosocial issue has more than doubled. It is also thought that the tidal wave of information from the media and the internet can make parents less likely to make a definitive choice due to the high chance of performing the “wrong” kind of rearing practice. Parental expectations and contexts can influence how they impart the priority of oral hygiene and how they interpret and employ the dentists advice.
Childhood fears can greatly influence a childs behavior and compliance. It should be determined whether poor behavior is due to fear and anxiety versus general non compliance. Four to 8 year olds fear is generally due to imagined problems while 9+ s more concrete and based on previous experiences. Todays families are very different from in the past: married, two parent homes comprise only 26% of American families and 8% have a working father and stay at home mother. Fifty percent of children live in single parent homes, 85% of which are single mothers. Gay/lesbian homes comprise 8-10% of American homes. Currently, 60% of mothers with<1 y.o. children work full time outside the home.
Language and cultural issues have also become apparent in the recent decades, with a significant portion of the US population with limited or no English proficiency. Asking the right questions and learning more about the home-life of your patients will facilitate communication and improve the child’s experience, as well as your own. Using a relaxed voice, acknowledging interests the child may have and talking to children at the appropriate developmental level are other important ways to communicate. Also, giving the children ample opportunity to make decisions regarding their experience will give them a sense of control which can allay their fears. Be honest and forthright both with patients and parents.
Behavior management techniques are similar to in the past, with the decreased use of HOME being the most significant change. Also, the use of pharmacologic treatments has risen dramatically. Distraction and TSD are still considered the most effective first line of defense.
Key points/Summary: Honest communication and prudent use of behavior management techniques is essential to modern pediatric dentistry but we must be wary of changes in societal and cultural expectations in order to maximize our efficiency and be able to handle any child who comes into our operatory.
Assessment of article: A very good article, but does sometimes stray into the “Kids these days!” territory.