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Zhou Y, Humphris GM. Ann Behav Med 2013; 10.1007/s12160-013-9566-7

Although counterintuitive, it has been reported in the general paediatric literature, that reassurance increases distress in children receiving invasive interventions. In addition, among other factors 'child distress appeared to be stronger in the anticipatory phase...than in the procedural phase...'. As part of the 'Childsmile Nursery fluoride varnish application intervention' (www.child-smile.org.uk/...childsmile/childsmile-and-fluoride-varnish.asp), 456 dental nurse/child interactions during the application of fluoride varnish, were each recorded for 5 minutes using video. The children were 3-5 years old. The application of fluoride varnish was associated with distress in almost one third of the behavioural sequences. Using multilevel logistic regression it was found 1) verbal reassurance (for example 'It's easy-peasy', 'It tastes like bananas', 'It won't hurt') promoted distress behaviour, 2) initial child anxiety increased the probability of distress, 3) 'Childsmile' training for the dental nurses reduced distress. However, other training which included child management, communication skills, and stress management, increased child distress.