The power of positivity in managing pediatric patient and parent behavior

March 22, 2016
The theme of this issue is "fearless and efficient pediatric dentistry," and this article expands upon the "fearless" part of that theme. 

Barbara Sheller, DDS, MSD

The theme of this issue is "fearless and efficient pediatric dentistry," and this article expands upon the "fearless" part of that theme. While the implication that some pediatric patients and/or their parents can be a source of stress and fear for dental professionals is clearly meant to be tongue in cheek, the truth is that some patients and parents can cause anxiety and distress for a pediatric or family dental practice.

The good news is that you are far from powerless in these situations; there is a great deal you can do to influence and improve the behavior of pediatric dental patients and their parents.

ADDITIONAL READING | Behavior management considerations in the pediatric dental patient

The benefit of raising patient and parent expectations

Some dental practices assume they will benefit from lowering customer expectations. After all, they reason, the lower patients' or parents' expectations, the less likely we are to disappoint them. However, smart practices realize that it's far better to raise expectations. The reason: What patients or parents expect to happen usually drives their perception of what actually does happen. These expectations are formed at very early stages. If the staff handles scheduling of the appointment warmly and effectively, and if the office décor makes patients and parents feel welcome at the moment they enter, they will naturally anticipate a positive experience. From that point forward, they'll be looking for reasons to confirm their positive expectations, rather than for reasons to find fault.

Managing behavior by managing the brain

The prefrontal cortex is the brain's center of abstract thinking, thought analysis, behavior regulation, and personality. This is the part of the brain that helps patients and parents determine if they like coming to your practice and if they want to continue to do so. It also affects how they conduct themselves during the course of their visit to your practice.

ADDITIONAL READING |Placing effective restorations in challenging situations with pediatric dental patients

The human brain interprets and reacts to nonverbal cues, including the appearance of the environment and the behavior of the dentist and staff. The most effective thing a practice can do to positively influence the prefrontal cortex is to soothe and satisfy the brain's social-emotional connections. It is critical to have your office and staff provide warm, welcoming signals to reinforce to patients and parents that they've surely come to the right place.

When a dental practice gets this right, things flow smoothly. But if you get it wrong, the road can be very bumpy.

Send the right signals

As a mom, I feel like I immediately sense when something is right for my kids, and I think most parents feel the same way. In the case of a pediatric or family dental practice, wrong environmental signals include things such as: stained or peeling paint, a mess of any kind, medicinal odors, "don't touch" signs, and old or uncomfortable furniture.

The right signals include: bright, upbeat colors; kid- or family-oriented music; kid-targeted activities in the waiting room; and, above all, lots of sincere, smiling faces. One company that does a wonderful job of creating practice environments that appeal to children and their parents is Imagination Dental Solutions (

Conserving coping skills

No matter how accomplished your chairside manner is, all pediatric patients will need to draw upon their coping skills once they are in the dental chair. They've already had to accept confinement in the car seat on the drive to your practice, and perhaps getting up and dressed earlier than usual or dealing with some other disruption in their daily routine. And that's why you need to minimize the need for kids to use coping skills in your waiting room.

You don't have to entertain kids in the waiting room, but you do need to capture their attention. There's a reason restaurants make crayons and coloring books available to kids while the food is being prepared. Crayons and coloring books can also work in your waiting room. If your budget allows, interactive games and electronic tablets are excellent ideas. Headphones are a "must" so older kids don't have to hear what the younger kids are doing, and vice versa.

Keep in mind that if you're making sure the child's attention is captured, then mom doesn't have to do it. Allowing mom a brief mental break will relieve anxiety and help keep her mood positive throughout the visit.

And here's one more tip that will reduce the need for both patients and parents to use their coping skills: Don't show dental education videos in the waiting room. While well intended, in most cases they will only draw attention to the fact that a dental procedure is about to happen.

Keep your focus on the future

Don't forget that you want your two-year-old patient to also be your patient at age 16. So make sure that your practice has a clear "family" orientation to it. If the décor and other aspects of the practice are too juvenile, they won't appeal to teenagers. To avoid having them say, "Mom, I think it's time I started going to a dental practice for grown-ups," make sure that your practice's appearance and waiting room activities have plenty of appeal to tweens and teens.


You can guide your patients and their parents to become "true believers" in your practice by giving careful attention to everything you do: how efficiently their appointment is scheduled, how warmly the staff welcomes them when they arrive, how engaging their waiting room experience is, how comfortable your chairside manner makes them feel, how clearly your post-treatment summary is communicated, and how promptly any post-appointment needs or concerns are managed. All of this requires a total team effort, even in a single-dentist office. The days of one person doing it all are long past.

Not only is a team effort required, but a team effort can be contagious and exhilarating. It's important that your patients and parents see that happy people work at your practice-dental team members who truly love what they do and the families they care for.

Barbara Sheller, DDS, MSD, is chief of pediatric dentistry and a staff orthodontist at Seattle Children's Hospital. She is affiliate professor in orthodontics and in pediatric dentistry at the University of Washington School of Dentistry and has held leadership and committee positions in organized dentistry locally and nationally. Dr. Sheller is a diplomate of the American Board of Pediatric Dentistry, a fellow of the American College of Dentists, and is currently president of the Washington State Society of Orthodontists.

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