Wednesday, September 20, 2017

The child’s voice: Understanding the contexts of Children and families today
Department of Pediatric Dentistry
                                                                             NYU Langone
           
Resident’s Name: Suhyun Rue                                                                                 Date: 09/20/2017
Article Title: The child’s voice: Understanding the contexts of Children and families today
Author(s): Harper, D. C. and D’Alessandro, D. M.
Journal: Pediatric Dentistry
Date: March-April 2004
Major Topic: Child behavior management and communication
Type of Article: Expert opinion
Main Purpose: Explore contemporary themes for improved contextual understanding of children and families today and their relationship to providing optimal pediatric dental care
Key Points: Enhanced communication and partnership building improves comprehension and compliance with dental treatment
Background:
·  Parenting practices have undergone significant changes in the past 15 years that have impacted children’s behaviors
·  Many factors have influenced parents’ disciplinary techniques with children
·  Pediatric dentists are expected to deliver care to children who may not always be as compliant as they need to be
Discussion:
·  Parenting practices
o Majority of surveyed pedodontists reported that parenting styles had changed for the worse during their career
o Availability of information influences parents, and increasing trend of raising children in violent environments
·  Childhood psychosocial problems
o Psychosocial problems are increasing in certain, if not all, demographics
o Inattentive behavior and impulsivity greatly affect compliance
·  Contexts for children’s dental interactions
o The child’s context is a function of age, health care experiences, and families’ existing attitudes toward dental health
o Younger patients are impressed with the newness of the office; they need to explore and move around
·  Parental and family contexts
o Parental expectations (of dentist, healthcare values, ability to pay, and lack of knowledge) influence family contexts
o If dentists ask for and provide basic educational information, they can increase competencies for dental care
·  Context for the pediatric dentist
o Dentists face difficult realities in treating disease within a limited time frame and decreased financial support
o Staff’s child orientation, style, and family centered approach are key in promoting positive dental care for families
·  Childhood fears and the dentist – difficult to distinguish fear and other personality characteristics (i.e. anxiety)
·  Developmental reactions of children – the reaction of fear differs throughout development
o Age 2-3 – more reactive to immediate situations and are literal in their framing of fears (strange places cause fear)
o Fears from age 4-8 are characterized as related to prior situations (past experiences and imaginative fears)
o By age 9 and older, fear is based more in personal failure and social peer situations
·  Changing families – the nuclear family has changed and child care has changed
·  Multicultural issues – beliefs and practices differ based on culture
·  Challenging children – difficult not only due to behavior, but also development, size, special needs, etc.
·  Pediatric pain management
o Effective methods for treating pain and fear of invasive procedures are pain medications, noninvasive techniques, and family-centered therapy
o Parental presence during invasive procedures may decrease parental anxiety
·  Communication suggestions
o Health care providers should begin to prepare children and parents at every opportunity.
o Multiple times over multiple days is key to successful communication
·  Behavioral management in pediatric dentistry
o Most behavioral management procedures are based on the general practice of distraction
Conclusions:
·  Enhanced communication and partnership building improves comprehension and compliance with dental treatment
·  Diagnosing the child and family within the immediate local context is central to developing and accomplishing an effective dental treatment plan
Remarks:
Assessment of Article:  Level III – expert opinion


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