February 19, 2021
by Kari Slade, RDH
I began my journey into pediatric dental hygiene in 2015, before we were aware of our son’s diagnosis. I had always been drawn to working with children and I quickly found my niche while working in a pediatric clinic in my community. In 2018, three weeks after the birth of our daughter, our then three-year-old son was diagnosed with autism.
Something I do not think people realize is the amount of time you spend in various offices before, during, and thereafter your family’s diagnosis. I always said I was very thankful to have been on maternity leave in the first year after we learned of our son’s needs as we were attending some form of therapy or appointment three to five times a week. It can suddenly feel as though your entire world is engaging with clinicians. Through my clinical experience and interactions with clinicians of many disciplines, I have adapted some useful strategies that can be easily implemented into any practice. By adjusting the clinical approach, utilizing the parent as a collaborator, implementing the Tell-Show-Do and Visual Schedule approaches to clinical services, and increasing our flexibility in the process of care, we are better able to meet and service the needs of children with care considerations in the clinical environment.
The first step in being well prepared to manage the needs of a child with increased care considerations is to approach with as much information as you can. By chart auditing in advance, one can Google anything they are not sure about, and make sure they go back and re-read any notes they may have about sensory preferences, abilities, supports, etc. I remember once meeting a parent for the first time and launching into an ‘education session’ about the link between chronic inflammation and diabetes, only to be corrected that diabetes insipidus, in fact, has nothing to do with glucose.1 It was an excellent learning opportunity for me about doing my research, and about a very under-utilized source of education: the parent!
Parents of special needs kids are often great sources of knowledge on their child’s conditions. Asking for their considerations and approaching the appointment with true collaboration will help to create a supportive environment for the parent and child. I’m always sure to take the time to explain to the parent what I’m doing, why I’m doing it, and that we can change the plan at any time to suit their comfort level. By explaining, “I’m going to lay Timmy back now to look at his teeth with the mirror. It is likely that Timmy will cry but crying means I can see very well. Nothing I’m going to do will hurt Timmy, but if at any point you have had enough, or feel like Timmy needs a break, please let me know and I will stop right away,” one allows the parent to feel their voice is heard and remind them that they remain autonomous over the appointment. It also gives the parent and child the chance to anticipate the next step, helping to remove anxiety around the unknown.
Another excellent way to remove the situational anxiety a child with special needs may feel is to utilize ‘Tell-Show-Do.’ Tell-Show-Do is an approach I first learned of in Darby and Walsh’s Dental Hygiene Theory and Practice2 and, in my opinion, it is an invaluable tool in the successful implementation of the dental hygiene care plan. Having care considerations can mean never ending clinical appointments; for a child with a communication delay, this often means different clinicians assessing you, without the opportunity for knowledge or understanding of what is happening. One can see how this could create an air of distrust for the child, causing a defensive response. Taking the time to tell a child what to expect, showing them the tools to be used and then working with them to complete the task allows the child to anticipate next steps.
Often, I will start the appointment by handing the child a hand mirror and asking them to show me their smile. By not jumping right in with physical touch, one provides the child the time they may need to adjust to the environment. Allowing the child to hold the mirror provides them some measure of control, and starting with a smile is an easy, non-invasive step. This hands-off initial approach can also provide assessment information such a gait, strength, symmetry, and profile. I then create a three to five step plan and repeat these steps often throughout treatment, so the child can anticipate what comes next. Something like, “First we will look with a mirror and check for sugar bugs with my tooth toucher. After that we will brush with a toothbrush, the Dentist will come to look with a mirror, we will paint your teeth with vitamins and then we will choose our prizes!” These steps that are laid out using simple language, explaining what is to be done and what tools will be used, and ending with a reward, will help the child feel some sense of control and remove the unknown element. Anticipation can often lead to anxiety for children of all abilities. After each step is completed, celebrate that accomplishment and remind the child of the remaining steps: “That’s awesome that we were able to look with a mirror and tidy your teeth, Lily. Now, we just have to brush with a toothbrush and have the dentist count.” Then repeat the steps, using similar language, throughout the intervention.
Similar to Tell-Show-Do, utilizing a visual schedule is another valuable option for allowing the child to feel secure, by removing the fear of the unknown. Visual schedules use small pictures on a strip to aid a child, especially one with a communication delay, in processing the appointment steps. This method is often utilized in other therapeutic modalities and is becoming more common in classrooms as well. There are a lot of online resources for pre-made, generic visual schedules, but I have found that taking in-office photos is an excellent option for real life expectations.
The last implementation aid to review is flexibility. This one may seem the most obvious, but it is often overlooked. Allowing for decision making and flexibility of environment can help a child to feel a sense of control over the situation. Children with mobility concerns may feel more comfortable in the support of their chairs, some children may prefer headphones to cancel noise, or to have the overhead lights turned off to reduce visual stimulation. I have done assessments sitting on the floor, standing against the wall, and even lap to lap with children who others may deem “too old” for such interventions. Another support option is placing lead aprons over an anxious child; acting as an easy to disinfect, readily available weighted blanket. Taking the time to take the child’s needs and preferences into account allows the clinician to build a rapport with the child, that often helps to break down barriers to care.
There are many considerations available to easily help reduce stimulation and improve treatment outcomes when treating children with special needs in the clinical environment. By using an adaptive approach, including the parent as a collaborator, utilizing Tell-Show-Do and visual scheduling while being flexible to the process of care, the dental hygienist can help create a clinical environment that minimizes anxiety, and models an inclusive approach for children of all abilities.
About the Author
Kari Slade RDH is an Independent Dental Hygienist, who has been passionate about her career since graduating in 2007 from Aplus Institute. She is employed with both a general practice, and a pediatric specialist office, and recently became the owner of Something To Smile About, providing dental hygiene services and Myofunctional Therapy in Brantford, Ontario. You can follow her on Instagram @somethingtosmileaboutrdh or view her website www.somethingtosmileaboutrdh.ca.
RELATED ARTICLE: Providing Preventive Dental Care in the Community for Persons with Special Needs
I found this article very interesting and very well written. Kari has her information well organized and for professional and nonprofessional people to easily relate to. Well done!
Children with special needs should be treated properly. When they are having health issues, more care is needed for them. Thanks. You are doing such wonderful work by providing health treatments to them.
Dentist Ross Township PA
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