10 top tips for a child-friendly environment

    The Children's Dental Health Survey 2013 revealed that in England, Wales and Northern Ireland only one in four 12 year-olds have no fear of the dentist. This statistic tells its own tale, but above all highlights the need to improve the child's experience when visiting a dental practice.

    Toothbeary, tucked away in Richmond, London, has been designed with children in mind. Every little detail comes together to ensure that Toothbeary is a place where children feel at home. Founder and principal dentist Nicole Sturzenbaum (above) offers ten top tips on how to make your practice a child-friendly environment.

    1. Think about the concepts

    As always, the first impression leads the way to how the child will feel and behave. For instance the reception desk: can you imagine how a child will fell walking into your practice and the only thing they see is a big wall and it will be impossible from them to see who is behind the desk. If you can't lower your desk then ask your receptionist to stand up and lean over the desk to greet the child personally to make them feel welcome. Obviously the choice of colours on your walls/ chairs or uniform can make a difference as well. Paediatric psychologists have defined schemes which make children feel comfortable. The stainless steel and white décor of a standard practice may look pristine to adults, but it is not an environment a child will feel comfortable in. In contrast soft colours such as blue, pink, green or yellow will have a calming effect on the child. Of course the waiting room is equally important as it supports the feeling that your practice is a place where they belong. I suggest you dedicate a corner in your waiting room with age appropriate furniture, games and toys.

    2. The work starts before the child even arrives

    The initial contact with the parents on the phone is very important. The receptionist should take the time to collect as much information about the child as possible (previous experiences, pain, anxiety etc.), so that everybody knows beforehand how to approach the child and what to expect when (s)he comes for the initial appointment. In addition, we send out a list of do's and don'ts to the parents to help them prepare the child for their visit. Often parents reassure their child by saying ‘there is nothing to be worry about’ or ‘it won't hurt’, which in fact implies that there might be something to be worried about! Children have no prior association of what a visit to the dentist is like, so why give them a negative one? We encourage parents to use positive words such as ‘fun’, ‘exciting’, ‘playing’ and counting teeth.

    3. Never treat the child on the first visit

    It is important you get the first appointment right, which is why you need to take the time to really get to know your new little patient. At Toothbeary the nurse will start seeing the child on her own and have a chat for at least 10 minutes about oral hygiene/diet and hobbies etc. This will make the child feel comfortable and relaxed. By the time I come in (and I am dressed in the same colours as the nurse), the child will already feel less intimidated by the whole situation. It is all about building rapport and trust. For this reason I only do an exam and do try not to treat children on their first visit, but instead let them go home with the positive feeling of having had their teeth counted and having been a good helper.

    4. It's about the child, not the parent

    Always try to keep the child at the centre of attention. At the end of the day, this is their visit and not the parent's one. Use open questions in a child appropriate language, which they can answer with ‘yes. Basic postulates of psychology state that if the child answers five questions in a row with ‘yes’, (s)he will not say ‘no’ when you ask them if they want to lay down to have their teeth counted. At the same time, your active listening will have a reassuring effect and imply that everything is normal. Of course it is important to discuss all treatment details/ possibilities with the parents and get their consent, so when you have finished ‘counting teeth’ ask your nurse to take the child to the play area while you talk to the parents. In this way you avoid that the child hears words they don't fully comprehend which can potentially scare them.

    5. Give them choice

    As any parent can testify to, giving children directives does not always work, especially when they are in an unfamiliar environment. At Toothbeary we give them choice. Choice over what DVD they wish to watch while they are lying on the treatment bench, choice over what they can exchange their token for and a host of other things. We always wrap positive messages into the questions we ask. For example I would never say ‘please get on the chair/bench now’, but rather ‘I think it would be a great idea if you would lie on the chair so you can see the movie better, would you like to try’?

    6. Positive reinforcement

    Positive reinforcement is a key component of success, not just with us, but for their overall development. Everything you say/do can be wrapped into a positive reinforcement. If a child is nervous or appears anxious, it is better to start with an easy appointment (like a visit to the Toothbrushing School or having fissure sealants applied). In this way the child will feel that they have achieved their goal and will reinforce the child's positive behaviour for the next visit.

    7. Tell the truth!

    Telling the truth is a fundamental principle of Toothbeary and the same should apply to parents. Parents should tell their children why they are visiting a dentist, but equally reinforce the positive notions. It is important to uphold the positive but true representation of the dentist. For example if the child asks if he/she will need an injection don't just say yes but instead emphasise that they will get a special children's injection with magic gel.

    8. Be prepared

    When it comes to the actual treatment the most important thing is to be fully prepared. Children have, at most, a 20 minute attention span. Therefore it is important to keep treatment times to a minimum while doing as much treatment as possible in one visit. That means everything has to be ready and the parents need to be aware and informed, so that they don't ask questions or interrupt the treatment. Prepare your equipment in advance and ensure it is out of sight when the child enters the treatment room. Then you can fully concentrate on the treatment and guide the child through the treatment and don't be afraid to use behaviour management, voice control or visual imagery.

    Ideally try to incorporate your nurse as much as possible to reduce the treatment time and best use a rubber dam, which will make the treatment safer and more comfortable. I always allow the parents to accompany their child to the treatment (but ask them to sit quietly in the corner of the room and let me lead the child through the treatment), this ensures that the child feels safe.

    9. You have one opportunity, so make it count

    If you do treatment then make sure it will last. If you feel the child won't cope and you don't have the facilities for sedation, then refer the child. Any treatment should be a long term solution, as there is nothing more traumatising than having to return to the dentist several times because of the same problem. A pleasant appointment, resulting in oral comfort is the best reward the child can get.

    10. Improve prevention education

    Personally, I believe dentists should focus more on prevention education. Parents always act with good intentions but some inadvertently can negatively impact on their child's oral health. For example, many parents believe that smoothies, juices, dried fruit or muesli bars are part of a healthy life-style, but in fact they are bad for your teeth. At Toothbeary we continue to balance education and prevention – in doing so we will continue to improve the oral health of children.

    Implementing any one of the above tips in isolation will likely not have much impact, however by integrating as many as possible you will improve the overall experience, patient attendance and ultimately promote good oral health of our next generation!

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    10 top tips for a child-friendly environment. BDJ Team 2, 15085 (2015). https://doi.org/10.1038/bdjteam.2015.85

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