Friday, February 19, 2016

Preparing for the Dentist

Before she became a big sister at the ripe ol’ age of 23 months, my firstborn had been to the dentist with me several times. My dentist was a friend from church, and he ordered me to bring my baby with me. I was aghast, especially when she began walking at well before she was a year old. I couldn’t watch her while lying on my back in his chair. My dentist wanted to normalize the dentist for her. He said his staff would chase her down the hall. No problem. I wasn’t so sure. His word was good. Sometimes, she sat on my stomach during my check-up. Sometimes she played with toys in the corner of the exam room. The dentist allowed my daughter to touch instruments, to look in my mouth, or to ignore the whole experience and play in the corner if she chose. I think that dentist is brilliant.

When my twins were born, I switched dentists to one near my home. Taking three little ones to the dentist was a challenge, yet I wanted the kids to see me in the chair. I wanted to normalize the experience. When one child regressed into autism, I chose to leave her at home with her dad for my visits for a while. When we got to the point where my child with autism needed a dental check-up, I began taking her to her brother’s and sister’s appointments. I came armed with toys and video games and I didn’t care if she participated or watched, but I wanted her IN the exam room during the exam.

Our dentist at that time was a mother of young children and she instinctively slowed down and allowed processing time in a way that made my child with autism successful. She even managed to fill a couple of cavities with no nitrous oxide.

Here are tips that have helped us to have successful visits to the dentist:

1. Ask other families for recommendations – who is your dentist and what do you love about him or her? Ask families who have kids with special needs. Ask families with typically developing kids. Pssssssst: The autism moms know who all the great professional are.

2. Plan appointments right after breakfast or lunch. Hunger and blood sugar affect a lot of our kids in a big way, and timing an appointment around a good lunch may stretch the child’s attention and time in the chair. The first appointment after lunch usually means you won’t have to wait.

3. We have had success with three family dentists. I hesitated on using a pediatric dentist because the pediatric dentist won’t see/treat me. When children rely on familiarity to help reduce anxiety, I’d rather have my child in the same chair at the same office that I use so she can see me in the chair. Additionally, some pediatric dentists have an open exam and treatment room with multiple chairs and the dentist does not allow parents back in that room due to privacy for other patients there at the same time. I want to be with my child. Which leads me to #4.

4. Make sure the dentist allows parents to accompany children back to the exam room. Not all do. Make sure the dentist allows the whole family to go back for one person's appointment.

5. Preview prior to your appointment. Use story books or videos about going to the dentist. There is a YouTube video for just about everything these days. Preview with a toy dentist kit.

6. MODEL. MODEL. MODEL. One form of previewing is modeling. Take the child to mom’s appointment, dad’s appointment, sibling appointments, grandparent appointments. MODEL by opening your own mouth when the dentist asks your child to open hers.

7. Consider the purchase of a children’s camera and allow your child to take pictures of you during your appointment. Make an album at home, talk about the trip to the dentist. Make a social story. (Budget saving hint: watch for cameras to go on sale at holiday time. There are some sturdy children’s cameras out there, now.)

8. Ask the dentist to allow your child with special needs to have a ride in the chair at your appointment or at a sibling’s appointment. Ask the dentist to count your child’s teeth when your own appointment is finished. When my child w/ autism was younger, my dentist always gave her a pair of gloves during my appointments. Sometimes, she came alongside and watched or ‘helped’ for a moment. We allowed her to come and go from chairside to toys in the corner with no pressure to watch.

9. Ask your dentist to use child terms during your appointment if your child is there watching. Calling the suction device, “Mr Thirsty” and looking for “sugar bugs” on my teeth still makes me smile.

10. Slow down. Wait. Use as few words as possible to communicate with the child. Ask the dentist to ask your child one time and give the child processing time to allow the child to be an active participant. “Open wide!” may take 30-45 seconds to process, and repeating directions may cause the child to have to start processing the direction all over again.

11. At the child’s appointment, take a pair of sunglasses to reduce glare and brightness. Sunglasses also help disguise dental instruments that may look scary to the child. I have noticed that dentists often have sunglasses for very young children but none big enough for tweens and teens. Take along headphones or ear plugs or ear buds connected to the child's favorite music.

12. At the child’s appointment, take a squishy toy or silly putty for the child to use as a fidget in the chair. If the child has a lovey (blanket, doll) or favorite toy (little matchbox car), bring it along.

13. Consider bringing a weighted blanket, heavy cotton quilt, or using the lead apron on the child in the chair for proprioceptive input.

14. Ask the dentist or hygienist for a list of what will happen during the appointment. Turn the list into a visual checklist on a clipboard and allow the child to check items off the list as they have happened.

15. Ask the dentist to preview. Our dentist had our daughter close her eyes behind her sunglasses for a shot of Novocaine while explaining gently that she’d feel a little pinch as the dentist put numbing medicine on her mouth and the dentist demonstrated where she would feel the pinch, told her she needed to remain still. The dentist waited until my daughter shut her eyes to bring the syringe close.

Sidebar: We avoid nitrous oxide because I have read that it interferes with B12 pathways and if you have MTHFR issues, nitrous oxide can be detrimental. Please do your own research.

16. Find a dentist with a massage pad in the chair and has a tv in the exam room. (Our dentist in our new state does not have a massage pad in the chair.) Allow the child to choose the tv channel. Schedule your visit during child's favorite show.

17. Should you have a situation that requires sedation and you are trying to avoid a trip to the hospital, know that in some cities, there are traveling anesthesiologists who will come to your ‘home’ dentist and sedate a patient in the familiar dental office. (http://nashvilleoba.com/ is one example)

Kids don’t know what they don’t know. And what they don’t know can create anxiety and frustration. Your child may need to watch others’ appointments and take several trips to the dentist before he/she completes a full exam, and that’s okay. Build up to it, slowly, if you need to. Preview trips with parents or sibs bridges the gap between what they don’t know to what they know without demands or pressure. I interviewed my daughter, curious about what she might say to parents and kids with autism about going to the dentist.

My daughter – the one with autism – has this advice to parents and kids about going to the dentist. Her list is a little bit shorter than mine: “The dentist is cool! Stay cool and stay calm and relax!”

Added 11-Oct-16, Bill Nason's post about tooth brushing is related and may be helpful:
https://www.facebook.com/autismdiscussionpage/posts/1159538140792351

1 comment:

Rachel Hertel said...

This is GREAT advice!

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