Management of the crying child during dental treatment

Resident: Hencler
Date: 09/11/2009

Article title: Management of the crying child during dental management
Author(s): Zadick, DMD, MPH; Peretz, DMD
Journal: Journal of Dentistry for Children
Pg:55-58 Year: Jan-Feb 2000

Major topic: Behavior Management
Type of Article: Observational/Questionnaire

Main Purpose:
To present parents’ attitudes toward their child’s crying in the dental environment and suggest a classification of crying children and discuss management implications.

Overview of method of research:
104 parents accompanied their children for dental treatment. Each child had 1 operative appointment following an initial exam. Parents were present during treatment. Parents were asked to fill out a questionnaire. Operator was asked to document assessment of child’s behavior and tendency to cry.

Findings:
No significant association between socio-demographic variables of the parents and dependent variables. Parents attributed a tendency to cry to their children much more frequently than the clinician. When the child cried, with no evidence of pain, most parents preferred the treatment to stop, calm the child and resume. Most parents felt they had to assist the operator in calming the child. Parents’ inclination to help a crying child was greater when the child was male. Using Frankl’s scale, operators assessed tendency to cry and found categories 1 and 2 children (uncooperative) were more associated with high tendency to cry.

Key points in the article discussion:
Parents much more frequently than operators classified their children with higher tendency to cry most likely because there children have used crying to manipulate them. This behavior may be exhibited in the dental environment in one form or another. In trying to sabotage the appointment a child may cry bitterly and without behavior management, treatment would seem cruel to the child, unsatisfactory to the parent, and exhausting to the clinician. This may imply that management of the crying child should involve the child and the parent. The child often lacks the ability to respond effectively to an adult authority and display avoidance behavior in the form of crying. For these children stopping the treatment may serve as a reinforcement to continue crying. The new classification focuses on the ‘crying child’ and not ‘the nature of the cry’ as appears in Elsbach’s classification.
1. The child who communicated by crying
a. Fearful
b. Resentful
c. Released (tension released)
2. The ‘crying type’
3. The manipulative child
When the diagnosis classifies the child as communicating a message, a soft, calming approach is preferred. The ‘crying type’ and manipulative child should both be managed with “matter of fact” approach. It is important to carry on with treatment so the child will not think that crying will affect treatment outcome. Instead of trying to stop the crying, let it be known that crying is allowed and will not help the child’s purpose in stopping the treatment.

Summary of conclusions:
The effective Pediatric dentist should have a wide variety of behavior management techniques in order to direct negative behavior and facilitate a more cooperative patient. Effective behavior guidance will result in more successful treatment outcomes. It is of utmost importance that the parents be informed of these techniques and consent to them before treatment begins.

Assessment of article:
Good article, not great. Bottom line is that every clinician will practice many behavior management techniques that will vary from child to child. What works for some clinicians will not work for others. I thought the questionnaire results were kind of interesting but not particularly surprising. The new classification may be helpful when deciding what behavior management approach to take with a particular crying child.