In practice - Children and young people
The following general points of attention apply to dealing with children in practice:
- Invite the parents to come to practice with their young child to get used to the environment.
- Focus the practice child-friendly.
- Do not let the parent or child wait too long.
- Connect with the child and the parent.
- Talk to the child at his own level.
- Speak non-threatening language, but be honest.
- Accompany the parent and say what will happen, so that it is calm and feels less insecure or anxious
- Be clear and radius rest.
In the dental practice
Prepare parents of a young child for the examination and treatment of their child. Invite them to take their young child to practice so that they can get used to the environment. Explain that their child can sit on his lap or lie on the belly of his mother or father. Also discuss how practice rewards a child at the end of the dental visit. Tell for example that the child gets a small reward from the dentist. From about the pre-school age, the child receives the reward when it cooperates to capacity.
When a child has to come frequently, a filler plate or a sheet with drawings of teeth can be effective. Each time one box can be filled with a sticker, or a tooth can be colored. Sometimes parents promise their child a gift themselves. This can lead to uncomfortable situations, for example when parents take the gift with them in the treatment room. Does the child receive the gift even if it has not shown the desired behavior? Some dental practices therefore ask parents not to take presents to practice.
There are specific points for attention for the treatment of children in the dental practice.
Points of attention in the treatment of children
- Make contact with the child, preferably already in the waiting room
- Coordinate your communication with the child and his / her parent / supervisor and what happens in the contact
|To the treatment room||- A parent can go to the treatment room; possibly also a brother or sister|
In the treatment room
|- Explain what you are going to do: tell-show- (feel-) do|
- Let the (young) child choose what it wants in the chair: on the lap (or on the stomach) of the parent lying in the treatment chair, or lying in the treatment chair
- Give the child, when possible, a choice: 'Will I first do the top (look, polish) or the bottom'?
|Keep in touch||- Keep in touch with the child throughout the process: verbally and non-verbally; keep talking to the child, look at him; hold his hand or stroke his hand or head|
- Use non-threatening words that match the world, the experiences and the imagination of the child:
- Dialing shower instead of drilling
- Sleep drops next to the molar instead of anesthesia
- Molar to sleep
- Caress your hands instead of holding them
- Can be sensitive instead of pain
- Not so easy instead of difficult
- You can notice that instead of you can feel that
|Handle the situation||- Make sure that the child has some control over what happens: say a sign that allows the dentist to stop, or let the child count to three before you lower the chair|
|Social reward and material reward||
- A reward immediately after the desired behavior reinforces that behavior; give the child compliments for what works well (social reward); do that immediately (after the desired behavior) and specifically; so not: 'You'll get ...' immediately a compliment
- Rather not general ('you're doing very well'), but mention specifically what the child does well ('you open your mouth very wide, pretty good', 'you're pretty quiet, you're doing very well')
- There are also non-verbal compliments (putting your thumb up during treatment, a high five after treatment); You can also have a child do something: press a button, let the suction device drink water from a cup, let yourself slide down from the chair
- After the treatment, a small material reward can follow (sticker, eraser, coloring sheet, tube of toothpaste); for a long series of treatments it is better to work with a reward card; for a certain number of points, a reward follows
A child who does not want to
A child can show in all sorts of ways that it does not want to: say that it does not want to, cry, scream, stay in the waiting room or run away, do not lie down in the chair, keep his mouth shut or keep it closed, keep his tongue moving, wiggling and moving in the chair, coughing, getting out of the chair.
Stay friendly, but be clear to the child about what you want from him. Sometimes you can make it easier for the child to perform the desired behavior. For example, by deriving it, asking a question and saying that he can give the answer about ... counting. Or you give a child who constantly moves his arms a stuffed animal to hold.
In other situations it is more difficult to let the child cooperate. A parent who has come to the treatment room often tries to call the child to order. In other cases, the child tries to get out of the treatment by the parent. In both situations the dentist and assistant lose control. The dentist can explain to the parent that a child often cooperates more easily when it is alone with a dentist and assistant. He can ask the parent to go to the waiting room. While you walk with the parent to the door you can reassure him. You can say that this situation occurs more often and that you will certainly not force the child.
When a child screams, walks away, holds his hands in front of his eyes, turns his head away, in short making contact impossible, you will have to try to catch his attention again: with a clear voice or just proceed to whisper. If a child does not respond to your invitation to make contact, you can just ignore the unwanted behavior and the child and not insist on contact. For example, by starting a conversation with the dentist about a non-threatening subject that connects with the child's environment: animals, swimming, a game, the youth news. You can sometimes also turn away from the child, but you must be able to see from the corner of the eye what the child is doing and that it is not at risk. Children who receive no attention eventually become confused. Then a new situation is created. The child becomes quiet, bores or becomes curious and then contact is possible again. The treatment team must keep on ignoring it for a while. If you get angry after a few minutes, you still reward the child with attention. Ignoring the unruly child for some time is not a lost time, because eventually a new situation arises, with contact. Most children succeed, now or next time, to cooperate with the control or treatment.
How you can deal with an anxious child in dental practice can be read in the following box.
Substantive points of attention
In a conversation with the child and parents or caregivers you discuss brushing: brushing technique and the process of brushing by parents, by brushing yourself with napoet by parents to brush independently. In addition, you provide information about fluoride, the possible use of a bottle and the number of eating and drinking moments. In teens you also discuss the use of energy drinks.
In the general practice
Practice assistants mainly deal with parents. Parents who are often worried about their sick child. The anxiety of the parents weighs in to the question whether your parent and child ask for a consultation or arrange a visit. You are aware that it is often difficult for young children to assess the severity of the symptoms without seeing and examining the child. The standards of the general practitioners' organization NHG for practice assistants and the triageklapper give indications for determining the urgency for various complaints. Practice assistants have to deal directly with the child when treating, for example, warts or vaccinating independently. Then, of course, they also coordinate communication with the child.
Young people deserve their own management (including adherence) and the subjects of contraception and STI attention. Here we discuss talking to young people in the general practice about sex, contraception and STI.
In comparison with young people in other countries, the use of contraception and condoms among young people in the Netherlands is quite high, but it can be improved (see next box). The use of contraception is lowest among 13 and 14 year olds, among Turkish, Moroccan and Antillean youngsters and among strictly Christian youngsters. The most commonly used contraceptive in young people is the pill. It is reimbursed up to 21 years via the basic health insurance package. Above 21 years of age, unless there is a medical indication.
Contraception and condom use in young people
More than three-quarters of young people between 12 and 25 use a condom the first time they have sexual intercourse. About half of the young people use the pill when they have sex the first time. A third uses pill and condom.
Talk about sex, contraception and STI
It is not difficult to talk about contraception and STDs, many practical assistants say. But talking about sex finds many assistants more difficult. And that really belongs, because how else can you discuss what causes a young person to contract or pass a STD, or how a girl gets pregnant? How do you ask about sexual behavior and risky behavior? What words do you use? How do you discuss opinions about responsibilities (is the boy or girl responsible for condom use?) And the indication of limits? How do you discuss 'myths' about the pill? How do you ensure that your patient is comfortable with such a conversation? How do you actually ensure that young people use your consultation hour? In Amsterdam, a trial has been set up for this: the assistant as 'love-coach'. Assistants who are going to do contraception and STD consultations themselves will usually receive training through the NVDA, the GGD, Sense or Soa Aids Netherlands.
What makes young people using contraception incorrectly or not?
- Insufficient knowledge
- Misconceptions about sex and sexual risks
- Difficulty to indicate your own limits
- Difficulty in planning and applying contraception in unexpected situations
- Costs of contraception
- Views, standards and social pressure.
In the pharmacy
Medicines that children use are mainly antibiotics, anti-asthma medicines, diabetes and rheumatism. The dosage is adjusted to the child, usually on the basis of weight. The child's body has a different relationship between water, muscles, fat than the body of an adult. Moreover, the breakdown and excretion of medicines is often different: with some drugs faster, with others slower. In addition, a child can sometimes react differently to a medicine than an adult. Consideration must also be given to the form and mode of administration: sometimes drinks or drops instead of tablets and capsules; a front room with inhalation medication.
Care for children with ASD in the dental practice
Doctor and dentist visit is best when a child or adult with AS experiences as few unexpected situations as possible. That is why it is important to prepare the visit well and to work with fixed procedures. This makes the course of the visit predictable and provides guidance. You can use the power of people with ASD to focus their attention on one thing and on their need for a fixed order. In the Tables below we mention points of attention for the preparation and treatment of children with ASD respectively. Most points of interest also apply to adults with ASD.
Preparation in the dental practice
Preparation by the treatment team
|- Discuss with the patient and his / her parents / guardians or carers which things make him calm or restless; they know signals well and can advise on the right approach|
|Structure and recognition||
- If more preparation visits are required, schedule the appointment on the same day and at the same time
- Provide a fixed space; make sure that there are always the same employees
- Make sure the patient does not have to wait long; early in the morning is often pleasant; Then not many hours pass when people with AS build up tension
- Estimate the treatment duration realistically, but as short as possible
- Agree what happens when the consultation hour / other appointments end: can the child with ASD be the first, or are the parents / carers called when the appointments come to an end? they can then ensure that they only arrive at the practice when it is their turn
- Work according to established procedures and record these procedures as completely as possible (order of spaces, people, materials and events / actions); use this to prepare the patient for the events
- Do not leave any parts in the description, even if they seem obvious; that does not have to be obvious for people with ASD
|Appointments||- Set up rules and make arrangements about the treatment (tell what will happen, dentist stops after 1 minute, raise a hand if the dentist has to stop earlier)|
Preparation of the patient
Handle the situation
- Make sure the patient knows what will happen. This gives the patient something to hold on and the feeling that he has control over the situation
- Tell, step by step, what will happen. You show and / or feel that according to the tell-show (feel-) do method. That does not always work in one preparation visit to the practice. Sometimes more visits are needed. Also pay attention to sounds and smells during a preparation visit
- Involve the parents / guardians / supervisors in the preparation. They can also tell the child / client what they will do after the visit. Then he knows what will happen that day, not just what happens to the dentist
|Visual material||- Some practices compose a photo book or make a video that the patient can view with his parents / supervisors. As a result, the patient learns the sequence and images. It is important that the photos or the film are completely correct (space, type of chair, (color) gloves, masquerade, lamp, instruments, order etc.). It must look exactly like it is now in practice|
Points of interest during the visit / treatment
- Make contact; stick to the agreements that have been made
- Coordinate your communication with the person and what happens in the conversation
- Work according to the fixed procedures and agreements made
- Provide as little as possible (extra) incentives (telephone, people who walk in)
|Why||- Always explain why certain things must happen; sometimes a good reason is enough to accept the situation|
- Reassure the patient by saying what he can do to feel less tense
- Watch out for any tension, name it too ('I think it's exciting for you'). Tell them that you understand that and that the treatment is going to start like this
- Stay calm and radiate confidence. This helps the patient to feel less tense and to have confidence himself
|- Make sure your patient is paying attention to you before you start with exclamation or instructions|
|Concrete message||- Give concrete assignments: 'open your mouth now; raise your arm to me; Put your arm on ... "instead of asking questions:" Can you open your mouth? "It sometimes sounds unfriendly, but for people with ASD that is clear|
- Avoid negative messages: 'you do not have to be afraid'; 'stop that'; 'do not')
- Formulate positive: indicate specifically what behavior you expect: 'you find it exciting. If you find it scary, you can pinch my hand "
|Short and concrete||
- Give your message short and powerful, in short sentences and do not tell more than is necessary; a patient with ASD often has trouble getting the core out of the message
- Use concrete words and avoid imagery and proverbs, which easily lead to confusion
- Use objects and pictures if possible instead of many words
- Tell everything, step by step, but not too much behind each other
- Add breaks so that the patient can process the information with ASD
- If necessary, repeat your message literally, with the same sentences; if you use other words, the patient with ASD may think that you are telling something new