Editor's note: Due to COVID-19, many practices are limiting the number of patients in the office at one time. Should this also include parents when their kids are being seen? This pediatric dentist’s perspective is something to consider.
As a kid my mom would drag me along when she went to the local mechanic for car repairs, to a small, dirty garage just off the scary dark alley behind his house. She didn’t trust the nice car dealers or large shops with all of their great up-to-date equipment. Plus, the local mechanic was cheap. In the garage there was a big handwritten sign with all the prices for the services he offered. At the bottom of the list, written in huge letters, was this saying: “DOUBLE THE PRICE IF YOU WATCH.”
I have thought of that sign throughout my life and used it jokingly many times. But you have to ask yourself: Was he trying to hide something? Was he shy? Did he really find a problem, or was he making stuff up? Did he have a secret recipe to fixing transmissions? Who knows, maybe he just hated people hovering over him or asking silly questions about why he was doing this or that while working. All in all, it was probably frustrating for him when he knew exactly what he is doing.
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I have practiced dentistry all over the world: India, Korea, Cambodia, Guatemala, and Africa, to name a few. Parents want to be in the back with their children here in the United States. But interestingly enough, it’s not just the parents. It’s whoever brings the child to the appointment—uncle, aunt, foster parent, neighbor, older siblings, and even grandparents. Why? I haven’t found a good answer to that yet. Many papers say that parents just don’t want their children to go in the back alone. Other reasons noted are distrust of medical personnel, fear/anxiety of the child, and the parent stating that the child wants him or her with them. I won’t go over all the past articles or research papers. In the words of my past professors, “You can read that on your own.”
I just got back from a dental mission to Guatemala. I treated hundreds of kids, and the only parents who wanted to accompany their child were those of infants and toddlers who needed lap procedures. Even with lap procedures, most of the time another volunteer would help—not the parent. This is not because the parent wasn’t allowed (I invited all parents to be a part of the treatment or exam); it was because of parent choice.
Parents’ attitudes toward being present with their children are different in different areas. To complicate it all, I have found that the same parent has a different attitude toward it on different days. Moods and attitudes can change daily.
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So I did some simple research on my own. Over a period of four weeks, I asked every parent/guardian about accompanying their child to the back. I asked them why they did (or didn’t) and their thoughts on it. And no, there is no statistical analysis or any of that stuff. They were simple verbal conversations with parents, one person to another, as if we were sitting in a barbershop shooting the breeze. Here is what I learned.
The majority of parents (and when I say parents, I refer to the person bringing the child)—more than 95%—were females or moms. Very few fathers or males came to appointments. The majority of female caregivers who desired to accompany their child stated that they wanted to come back because they felt it helped the child feel more comfortable, offer moral support, and subsequently behave better. So I went the extra mile and had the caregiver leave for a minute to “sign a consent form the front ladies forgot.” Then, I asked the child if he or she was nervous or wanted mom back. Most kids age six and above stated they were not scared and didn’t really care if mom was back or not. Younger kids (five and below) liked mom back to hold their hand or just watch over them; others were too busy watching cartoons to even notice I was talking to them. Older kids (seven to 10) did not seem to care either way, but there were a few who actually stated they wanted mom with them. The ones who did are very anxious children in general.
About half of the caregivers later admitted that they came back not because the child was anxious but because they themselves felt anxious, and it helped them deal with their own anxiety. I even “interviewed” moms with teens age 13 to 20 who desired to accompany their children (yes, I have a few pedo stragglers). They responded in a similar way. They thought the child was nervous and wished for mom to be present. But not a single teen actually said he or she was nervous and wished mom were there. Most were quite embarrassed their mom came with them. Several asked them to leave.
Other responses from moms were varied from not wanting to wait by themselves in the front to, “I like the cute dentist”—that’s me! Some moms told me they thought they had to come back. I really liked how a few moms told me up front that they didn’t trust us (the practice) enough for their child to be alone. OK; I get that. These were all new families to the practice; not a single mom who had been with us for a while said that. But I’m sure it that was on their mind when they were new to the office.
I am grateful for those truly honest moms. It has given our staff an opportunity to show them how good we can be. As an aside, I asked these same moms the question after a few operative appointments, and their answer was very different. They trusted us. However, we have one mom who has been part of the practice for five years who still comes back out of distrust for any health professional. She asked me not to take any offense with that.
The parents who remained up front, stayed in their car, left for grocery shopping or to pick up another child from school … when I asked them if they had wanted to accompany their child, they didn’t really have much to say other than they felt no need to accompany the child. Their reasons varied from: “I don’t want to.” “Why would I need to?” “They don’t want me back there.” “I have other stuff to do.” Some were confused and thought I was suggesting that they needed to accompany their child. I asked all of them if they had trust in our team, and they all stated “yes.”
Most of us agree that the kids are the easy ones to work with. It’s the parents who make the process difficult. I found an internet forum that discussed whether or not parents should be allowed in the back. Those parents who weren’t allowed in the back were upset. Some were almost scary and threatening (due to their ignorance of the facts). Most truly distrusted the health professional. There seems to be a major lack of respect for people with authority or experience. I find this quite sad. I do understand that there are licensed professionals for whom people have reason not trust, but that has to be a small percentage.
So here is my take on the matter: Heck! Let them come back! I implore it; I welcome it; I encourage it! Let the parents witness your skills in treating their loved one. Show them how good you really are and why they choose to see you. Show off! Welcome that crying child and the hover mom to the back and show them that in five minutes you can have the child laughing, sitting still, and giving you high five on the way out the door. But set some rules with these parents. Stress that it is critical that they be silent observers.
Also remember that there are times when it is completely appropriate for you to ask the parent to leave the room or not accompany the child. You will know when these situations arise. The patient is usually unable to focus on your attempts to manage because the parent is in the way or overbearing. Ask the parent to leave so you can get the child’s full attention. You can also use the parent as reward and invite mom back in when behavior is better, but only if you know that she can be a silent helper.
You have to become an expert in figuring out the type of parent and child you are dealing with. Teach the parents! Even trained ER nurses who know better need to be reminded of the rules so things can go smoothly. It’s a good thing to allow the parent to see how their child acts. Most haven’t seen their child act under stress. Some are in shock that their child can act the way he or she does; some are oblivious (as the behavior is par for the course) and they believe the child is doing well. Seeing firsthand any poor behavior helps when you suggest sedation.
I have a few suggestions for you. Always bring parents to the back for first-exam visits. Take time to get to know them. Allow them to get to know you so you can start building that relationship of trust. Use your skills to determine who is a good candidate to ask to stay in front for any next appointments. Have those good conversations with parents. It’s OK to be the expert authority in the office, because guess what … you are! Be kind, reasonable, and give reasons why you recommend separation. In my opinion, special-needs children should always have a parent with them. Trauma or emergency visits are a perfect time to welcome parents.
It is appropriate to separate parent and child when needed, but explain to the them why it’s needed. After the procedure, thank the parent and be excited about how well the child performed. If the procedure was not successful, explain why. Many parents will attribute their child’s difficult behavior to them being separated, but explain that that may not be the case.
Most of this can be boiled down to your relationship with the child and parent. You have to be the expert, and they need to know that you are. The need to accompany usually dismisses with trust and knowledge that you are an expert and are trustworthy. Some parents will always hover and get in the way of good treatment; some will run from room to room checking on kids whether or not you or the child like it.
Despite what I have read in past research papers, I have learned that children do act differently when their parent is present versus when not present. In my experience—for the most part—children are better without the parents. They don’t cry and make a scene for my staff or me. They don’t care about us, and we don’t reward poor behavior. But they will behave in certain ways for their parent who can promise a pizza or iPad if they get their $40 sealant done. So separation can be important to completing work.
Some parents will not trust you no matter what. If you can’t come to a good agreement and treatment is being compromised, it’s OK to ask these parents to seek a second professional opinion. Most of the time parents come back when they realize you were right and had their best interests in mind. They often become the best office parents.
It’s important to note that parents’ anxieties do transfer to their children. Having a fearful parent in back with you can be quite distracting and lead to compromised care. Having good conversations with parents and setting ground rules will definitely help.
Some parents believe it is their right to be with the child, while some consider it a privilege. Google “parental rights” or go to parentalrights.org. It’s quite interesting what the law has to say. Parents have fewer rights than you might think, which is kind of scary since I have five kids! I’ve always found it interesting that parents will drop their kids off at school with unknown persons who may or may not have ideal training, and yet put up a fuss about a 30-minute appointment in an office with highly trained, credentialed, monitored, licensed professionals.
I understand the whole discomfort most providers feel while being watched by parents. I have it too. It’s uncomfortable! When they hear their crying child, most assume you’re doing something wrong or you didn’t numb correctly. Those are the times I think that mechanic had it right. However, I truly believe it is a time for us to shine. We have nothing to hide. We are honest professionals with good skills that parents should see and believe. Seeing is believing! Show off a little; you’ve earned it. If you need to separate the child and parent, do it and don’t be bashful. Be clear, kind, and honest but be the authority. Parents worry about their loved ones—that’s a good thing. You can tell your parents: “Trust us; we have you and your child’s best interests at heart!”