For many children, the thought of attending a medical or dental appointment isn’t a cause for concern and they are able to attend and handle it without a second thought. However, for others, this might not be the case. A seemingly routine appointment can be a trigger for difficult emotions and behaviors for a child who has experienced trauma. In this article, principles of trauma-informed care will be discussed as well as ways to provide children with the safety that they need during their dental appointments.
From the moment that a child walks into a dental office, it is vital that professionals are aware that each child’s life experience looks different. As a result of these differences, each will respond in a different way to dental procedures. You will likely even see differences between siblings—this is both normal and expected. It is best practice to assume that anyone whom you may encounter during the course of the work day may have a trauma history or might be living with chronic stress. When this is a routine practice, it changes the way that professionals interact with one another, with their staff, and with their patients. According to the CDC, at least one in seven children have experienced child abuse and/or neglect in the past year, and you will not necessarily know that one of those children are in your chair. Thus, we must approach everyone with an understanding that we have not walked in their shoes and should be mindful of their needs, boundaries, and personal experiences.
It is vital to be as informed as possible prior to working with children, keeping in mind that life circumstances and situations might change between appointments. Professionals should consider their intake paperwork and how they check in with parents/caregivers in order to be kept aware of anything that might be concerning. This will allow the professional to create a safe experience for the child.
Attending a dental appointment presents a number of challenges for a child who has a history of traumatic experiences. For example, one area of consideration is the design and layout of the dental exam room. For children who have experienced trauma, it may be important for them to have a caregiver with them, or within their line of vision. Some children may respond negatively to having the door closed, or to facing away from the exit. While we cannot always change the arrangement of an office, it is important to consider these variables and do what we can to make the space feel as safe and comforting as possible.
Another concern is the issue of consent. Many children who have experienced trauma feel out of control or like they have lost control of their bodies. They may already have had experiences where their bodily integrity has been threatened or violated. Other children may not have been taught about consent and body safety. From the first moment of your interaction, dental professionals should ideally work to obtain consent from the child prior to proceeding with any procedures. This can, and often should, be done in conjunction with the parent or guardian in attendance as well. It is important that children learn who are safe people to be touching them and that any resistance to the procedure is respected. It can create unnecessary trauma to force a child to comply with a procedure. Best practice, in terms of potential trauma or anxiety, would be to allow the child to take the lead. Asking permission in the presence of their parent or caregiver is ideal so that a conversation can happen should a child be anxious, upset, or triggered.
Another way to support children who have experienced trauma is to describe or narrate what you are doing before it is done. Answering questions and providing reassurance can go a long way toward easing anxiety. Quick, unpredictable actions or sounds can trigger children who have experienced trauma. Creating predictable routines in your office will help children to know what to expect and help them feel calm and in control. Some patients might benefit from the use of a video, pictures, or social stories in order to learn about dental procedures.
Finally, it is important to enlist the help of, and engage, parents/caregivers. Children take their cues on how to respond to situations in life from the important adults in their life. Coaching parents/caregivers on how to talk to and prepare children for visiting the dentist can make all the difference, especially for those who have experienced trauma. Review with them that their own attitudes, thoughts, and concerns will affect how their child reacts. Encourage them to talk with their child about the dentist and to not keep the visit a secret. Children with trauma need predictability in their life and talking about an upcoming visit will allow them to mentally prepare and express any fears they may have. Share with them basic strategies, like deep breathing exercises, that they can work on together with their child in preparation for the appointment. Advise and coach parents/caregivers on how to talk positively about the dentist, and to emphasize the positive aspects of proper dental care. It may help to read dentist related storybooks, or even have a pretend visit to the dentist beforehand.
Remember, dental professionals are mandated reporters and any concerns identified related to abuse, neglect, or other circumstances should be reported to Childline. In Pennsylvania, Childline is 1-800-932-0313. You can also file reports electronically at: www.dhs.pa.gov/KeepKidsSafe/Resources/Pages/ChildLine.aspx.