Key Points
- Children have a high calorific requirement.
- Children who are poor eaters at mealtimes and snack and drink frequently between
meals are more likely to get decay.
7.7 MANAGING BEHAVIOUR
7.7.1 Managing the preschool child's behaviour in the dental setting
The importance of establishing effective communication and adopting strategies
which help to alleviate anxiety, in both child and parent, have already been fully
discussed (293HChapter 2). Where possible, restorative treatment should be carried out
under local analgesia alone, but strategies such as sedation, by either the inhalation or
oral route, or general anaesthesia are sometimes indicated, especially in young
children with extensive disease who are in acute pain, or where a non-
pharmacological approach to behaviour management has failed (294HChapter 4).
Whichever strategy is chosen, it is essential to involve the parent in the decision and
to obtain written consent.
The fundamental principles of effectively managing child behaviour in the surgery are
fully covered in 295HChapter 2. However, there are some specific aspects that relate
particularly to very young children.
7.7.2 Parental presence
This has been a topic of great controversy for many years. Dentistry for children is
complicated by the fact that the dentist must establish a working relationship and
communicate effectively with both child and parent. Virtually all studies designed to
investigate the effect of parental presence in the surgery on the child's co-operation
with dental treatment have failed to demonstrate any difference between behaviour
with or without the parent present. Only one reasonably well-designed study, by
Frankl in 1962 (from which came the useful Frankl scale), has ever suggested that
parental presence might affect child behaviour. Frankl's results indicated that children
of around 4 years old and younger behave more positively when parents were present.
However, no difference was demonstrated in older children.
In most of the aforementioned studies, parents were carefully instructed to sit quietly
in the surgery and not to interfere with dentist-child communication, so as to avoid the
introduction of inconsistent variables. Frankl commented upon this in his concluding
comments:
the presence of a passively observing mother can be an aid to the child. This can be
accomplished if the mother is motivated positively, is instructed explicitly and co-
operates willingly in the role of a 'silent helper'.
Certainly having the parent present in the surgery when treating young children
facilitates effective communication and helps to fulfil the requirements of informed
consent. It also has the advantage that should any problems arise, or the child
becomes upset during treatment, the parent is fully aware of the circumstances and of