Today, I attempted to do some fillings on a highly anxious nine-year-old girl. She was sobbing practically non-stop, grasped tightly to her stuffed animal, and basically blocked/ignored all of my various behavior management techniques. Mentally she did not succumb to the oral sedative, she could not care less for my tell-show-do spiel, and she could not bring herself to stop crying well enough to tell me what was frightening her. The mother denied any past emotionally-distressing dental visits and claimed she behaved perfectly fine with her other medical doctors. Needless to say, I accomplished nothing in the office and her parents were made aware she will likely need to go under general anesthesia to get her dental treatment done.
Very few of my appointments are completely aborted like this one was. In fact, the rarity of it is probably why I am so heavily bothered right now; and I only wish I could have more effectively understood this patient’s disposition. In a child with a learning disability or mental health issue, (at least to my aberrant mind) there is more of a justification to why that individual may not be able to tolerate such a procedure. However, a supposedly healthy, ‘normal’ nine-year-old (with a stuffed animal?) without any previously traumatic dental appointments acting with such resistance really makes me question her resilience and coping skills for other difficult situations in her life.
There are some psychology concepts we briefly discuss in pediatrics such as (B.F. Skinner’s) operant conditioning, and positive/negative reinforcement and how each influences desired behavior. I also try to stay mindful of the developmental milestones children should be achieving, and try to raise awareness and arrange appropriate consultations when they are clearly not being met. The patient I had today clearly exhibited extremely fearful behavior (i.e. crying uncontrollably), still relied on comfort objects (i.e. stuffed animals), and willfully refused to be verbally interactive. Let’s assume she is not developmentally delayed; when someone exhibits such uncooperative misconduct, and realizes it provided her the outcome she desired (i.e. not getting dental work done) – my concern is, could that moment reaffirm in her mind that poor behavior rescues her from all circumstances she deems uncomfortable? What is the lesson she took away from today’s visit?
It begs the question though, where does parenting style play a part in all of this? In the few moments I was in the room with her, this parent met the criteria of a stereotypical “helicopter mom”; in that she hovered closely over the child the entire time (never once out of reach) and a bit overly involved in trying to pacify her daughter throughout the process.
Now, by no means do I profess to be the perfect parent. Far from it in fact. As you may know, I have two young boys. One has a borderline addiction to Minecraft and the other has a very unhealthy affinity for watching scary YouTube videos featuring Slender man. One tends to be clueless about his surroundings, messy and irresponsible with his belongings; while the other can have uncontrollable temper tantrums, often times is quite passive-aggressive, and (no joke) may one day turn out to be a kleptomaniac. At eleven and eight years of age – they already seem to know the full catalog of curse words, they consistently stay up past their bed time by at least an hour, and disobediently raid our pantry in search of sugary snacks.
In retrospect, I am starting to realize just how often I inadvertently enabled my children’s undesired behaviors over the years; all under the guise of trying to be ‘supportive’. Like when my son forgot to turn in multiple assignments throughout the school year, and my wife and I pleaded with their teachers to accept their work late. Even with minute challenges, like tying their shoe laces for them or cutting up their meals into bite-size pieces – these were obstacles they could have easily overcome and a great opportunity to build up their confidence.
It is perfectly natural to want to protect our children from difficult situations, or experiencing failure, or enduring pain, or undergoing embarrassment. Before we know it though, they’re older – and if we have shielded them from all of their struggles, I feel we may have deprived them of developing essential coping skills and the ability to build up resilience.
“We don’t grow when things are easy, we grow when we face challenges.” ─ Unknown Author
Within my own life, I know conflict has always helped me be more confident and grow as an individual. There is a sense of empowerment when we face fears and overcome obstacles. Lately, I not only ask my children to exercise perseverance and more independence through the problems they face within their own lives; but also, allow them to suffer more consequences and tackle some relatively uncomfortable situations without parental intervention.
I wish every child I treat in my clinic could have a pleasant and pain-free dental experience. Many kids unfortunately are overwhelmed with fear and anxiety before they even step foot into our office. “We are a sum total of all our experiences.” (BJ Neblett). I do not presume to be able to correct the behavior of every child within my one-hour appointment. Their past dental experiences, their environmental influences, their parent’s parenting style, and much more are all considerable factors. Fortunately we have various treatment modalities, and perhaps with time and enough positive experiences, even the nine-year-old with the stuffed animal can one day feel comfortable getting work done in the dental chair.
Thank you so much for taking the time to read this post. Please feel free to express your own thoughts and feelings on this matter, I love to hear various point’s of view.