Management of the crying child during dental treatment

Resident’s Name: Anna Haritos Date: September 5, 2008
Article title: Management of the crying child during dental treatment
Author(s): Zadik, D, et al.
Journal: Journal of Dentistry for Children
Volume (number): n/a
Month, Year: Jan/Feb 2000
Major topic: parent’s attitudes towards their child’s crying during a dental visit
Minor topic(s): classification of crying types in children
Type of Article: scientific prospective study
Main Purpose: to present parents’ attitudes toward their child’s crying during dental care; to classify crying in children and relate it to management of the child
Overview of method of research: A questionnaire was distributed to 104 parents after their child had completed an initial dental evaluation and an additional operative visit. Parents were prepped on the range of behavioral approaches used prior to treatment. Parents were present in the operatories during dental treatment. The questionnaire addressed both parent and child’s demographics & prior dental experiences as well as parents’ education, occupation, preferred method of crying management used by the dentist, and what role they should play in managing the child’s crying. The dentist assessed the child’s behavior and tendency to cry at the end of the visit. Statistical analysis looked at the association between variables. A Chi-square test was run with a significance of P<0.05
Findings: When a child cried, most parents preferred the operator to pause treatment to calm the child down and then recommence when the child was relaxed. Most parents felt they should help the operator calm the child down. A significant difference was found in parents attitudes depending on if the child was male or female – parents were more inclined to help if the child was male. A significant association existed between a child’s Frankl behavior score and a tendency to cry. Parents were more likely than the operator to assess the child as ‘likely to cry’. Of the children in the study, 56% were males, 44% were females, and the age range was from 2-13 years of age. 82% of the children had had previous dental treatment and of these children, 70% had required pharmacological sedation. 48% of the children had fully cooperated with the previous treatment while 28 % were totally uncooperative previously. There was no significant association between sociodemographic variables of parents and the dependent variables.
Key points/Summary: A child can use fear as a catch-all and an excuse for misbehavior when there may be other explanations behind his/her actions. Elsbach defined four types of crying: 1) fear-motivated (w/hysterical behavior) 2) pain-motivated 3) compensatory-motivated, and 4) steady state siren-like. These authors present a new classification for crying, based on ‘the crying child’: 1) the child who communicates by crying (a) fearful, (b) resentful, (c) tension released; 2) the ‘cying type’; 3) the manipulative child. The authors propose the following operator approach to the above crying children: the first type is responded to with a soft, empathetic tone; the second ‘crying type’ is approached with a matter-of-fact tone while continuing with treatment; the third type of child should receive a matter-of-fact response but with a decisive attitude from the operator with indication that crying is allowed.
Assessment of article: Interesting approach to classifying crying; The age range seems to be too large a span but this may be a source of another study to see if there’s a breakdown in parental perception based on patient’s age.