As parents, our children are the most important people in our lives. They love us, they depend on us, and they need us. We owe it to them to do everything we can to take care of them. They become the center of our lives and the reason we exist.
Nothing can match the wonderful feeling you get by seeing the smile of your child. Just as much, nothing can match the pain you feel when you see terror in your child’s crying eyes. Our children’s smiles are our responsibility.
Not all children can be treated the same, however. Some have more fears than others, and some require more care than others. You have to treat them and care for them as individuals.
One of our many ways we take care of our children is by taking care of their health. Given to themselves, children don’t always make the best decisions regarding taking care of themselves. Some, in fact, are very bad at it.
Taking care of your child’s health isn’t just about watching what they eat and making sure they get plenty of sleep and exercise, it also means making sure they get quality medical and dental care.
Ah. Did you cringe a bit when I mentioned dental care?
Fear and dental care
It’s estimated that as many as 75% of US adults experience some fear of dentists. This fear can cause people so much anxiety that they avoid necessary dental care to be healthy. In fact, in a survey on dental avoidance, over 15% of respondents avoided the dentist for over a year due to their fears. This avoidance can cause major problems.
Not only can avoiding the dentist cause you to not have shiny, white teeth and a great smile, it can have other health consequences – some of them quite severe. Mayo Clinic reports that the lack of oral care can contribute to cardiovascular disease, premature birth, diabetes, and other severe health issues.
Going to the dentist is important.
Now imagine the fear a child has about going to the dentist. Do you remember what it was like? Dental visits can scare children like no other dental visit. They’ve heard the horror stories from their friends, cowered at the sound of a whirring drill digging a hole in their mouth, and felt the ache of teeth as a dentist starts working on a cavity before the numbness has set in. No wonder children won’t go unless you force them.
Now imagine as much as you can, being a child with Autism Spectrum Disorder – more commonly known as ASD, or autism. You’re taken out of your routine, dragged across town to a new building, walked into a room with strange people looking at you, sat down in a strange chair, and have an overload of very negative inputs all at once – an absolutely terrifying experience. In fact, it can be one of the most traumatic experiences of that child’s life.
I understand completely that not all autistic children are the same. They’re people, just like everyone else. They do, however, generally have some traits in common with other children with ASD, and it is those generalities that I’ll address because they are the most commonly-understood. You know your child better than anyone else on the planet, and that’s unlikely to change. You are their champion.
Due to the anxiety that children, and especially autistic children show with dental visits, some parents choose to opt out of taking their child to the dentist as often as they should – just as they opt out of going themselves. There has to be a better way.
Dr James Knight, D.D.S. explains:
“All children, autistic or not, need to have healthy and clean mouths. Some parents believe the best solution is to keep anxious children away from the dentist. This ‘solution’ tends to emerge in particular when the parents themselves harbor their own anxieties about dental procedures, and hesitate to transfer those fears onto their children. I cannot stress this enough: keeping an autistic child away from the dentist is not a solution. A fear of the dentist can be overcome when a responsible parents works in conjunction with a competent and caring dental team.”
Sensory Adapted Dental Environments
Traditionally, dentists have had to go to extreme measures to take care of patients who have an extreme aversion to dental medicine. These measures sometimes include sedation, general anesthesia, or even physical restraint.
Some, however, feel that there is a better way to care for children in the dentist’s office, and especially extremely anxious children such as many of those with autism. They feel that non-pharmacological treatments can be made as effective as using some drugs.
The Division of Occupational Science at USC has done a research on exactly this, spending over half a million dollars to learn how to reduce the anxiety of children, especially children with autism, by changing the environment of the office. This study is called Sensory Adapted Dental Environments, or SADE.
SADE intervention includes such adaptations as dimmed lighting, exposure to soothing music, and application of a special vest which provides deep pressure sensations that are calming. These changes focus on affecting the child’s environment instead of the child. They specifically target the triggers that some autistic children have to make them feel anxious.
In addition to SADE, there are certain things that you and the doctor can do to help make the experience less traumatic for your autistic child. In fact, these things can help ANYONE reduce their fear of the dentist.
The Pre-Visit Meeting
One of the most important things you should do is have a pre-visit meeting with the dentist without your child present. Ask if they have experience with treating autistic children. Have them discuss with you what processes and equipment they would use to treat your child. Explain to them about your child’s behavior, and especially any specific triggers that cause anxiety.
Come up with a plan together on what each of you will do to make sure this visit goes well. There are certain methods that you and the dentist can use that can work extremely well with children, such as turning on the TV or having them listen to their favorite music through earphones.
Discuss with him about what steps you would like to take to ensure your child’s oral care, as well as what steps you would like to avoid.
Explain to the staff that they should praise your child for any good behaviors immediately and ignore any unproductive or disruptive behaviors as much as possible.
Work out some system of tell/show/do so your child will understand that something is about to happen, be shown what it is like to have it happen, and then have it happen.
Some children respond well if they’re told how long each step will take, such as “I’m going to have you hold this in your mouth until I count to 5 …”
Fear and anxiety can be reduced by giving people control over what’s happening to them. The more you allow your child to feel that they can stop something if they want to, the more comfortable they’ll feel about allowing it to happen.
Also discuss what control you’ll have with the procedure. Come up with a hand signal or a code word that will tell the doctor that you think he should back off of what he’s doing – or even stop altogether and come back another time. You need to feel in control as well.
This pre-visit meeting will not only help your dentist know the best way to treat your child, it will also help you to know what’s going to happen.
Pretreatment Conditioning
One of the best ways to help an anxious person is to take away the unknowns. Unknowns cause fear. You should allow your child to see, hear, smell, and experience as much of the dental experience as they can before they actually go to their appointment. This is called pretreatment conditioning.
Due to the comfort that many autistic children find in patterns, you should consider a phased approach to this conditioning – starting perhaps several weeks in advance. This will obviously require time and prior planning but how your child experiences life is important, just as proper medical care is. Some children require much more adjustment time than others and it’s important that we try to accommodate those needs.
- Consider introducing the topic by speaking to your child about their teeth and about how to take care of them. Mention that there are special doctors who can help take care of teeth. Make a habit of discussing this as your child brushes their teeth. Make a point to start approaching up some of the things that will happen at the appointment.
- Try to make understand that going to the dentist is a very normal thing to do. There is a book you should consider reading to them called, “Chicken Boy: A Super Hero with Autism Deals with Doctors & Dentists”. In this book, the hero of the story is a normal boy with autism who pretends to be Chicken Boy in order to cope with the outside world, and how he deals with the sounds and experiences of going to the doctor or dentist. It’s a great way to allow them to live vicariously through someone they can relate to and helps you create a social story to explain to them what will happen during the procedure.
- Make it a point to drive by the doctors office a few times before the visit so they feel comfortable with being in that area and it starts to be more familiar to them.
- As the visit comes closer, pull into the parking lot of the dentist and park near the building. If they seem comfortable, consider pointing the building out and mentioning taking care of their teeth.
- A couple of days before the visit, pull into the parking lot and walk up to the door of the dental office. Let them know that this is where that special doctor is who can help take care of their teeth.
- Visit the doctor’s office with your child one day and just sit in the waiting room. Let them get used to the sights, smells, and sounds of the office.
- Arrange a special meeting with the dental team before your child’s appointment. Introduce your child to the staff. Take your child through the same steps that you’ve done so far but allow them to go back to see the chair that they’ll be sitting in and look at the dental equipment that will be used.
- You may also want to bring along a sibling or a friend and have your child watch the dentist go through with a mock procedure.
- Also bring some kind of security device like a Rubix Cube or whatever makes the child feel comfortable at home.
- Incorporating your prior pretreatment conditioning into the examination, such as bringing your child’s toothbrush and reading or mentioning related parts of the Chicken Boy book or other methods may be helpful to help maintain structure in the process.
James Knight:
“Ultimately, when an autistic child needs to relax in a dental office during a procedure, the majority of the responsibility will fall on the dental team to make sure that takes place. A good dental team will explain to you and your child what is happening and which items will be used during the procedure. An autistic child may feel more relaxed if he or she is able to see how the tools work, hear the noises they make, and see a member of the dental staff demonstrate the equipment to confirm that each item is safe and pain free. A good dental team will work quickly to ensure that your child doesn’t become exhausted and stressed as the procedure progresses. Some dental offices offer an in-room television set or headphones so that your child can be distracted from the procedure and put at ease.”
Projecting Fear
As I mentioned before, you are your child’s champion. They look to you for protection. They will pick up on any fears that you have. If you’re scared of going to the dentist, they will pick up on that. If you’re scared of them going to the dentist – they will definitely pick up on that. Make sure that you become very comfortable with the process and are very calm and happy when discussing it. They need the care – you need to do this.
You can do this
With some prior planning and extra love and care, you can make sure that your autistic child can get the care they need, and it doesn’t have to be such a traumatic experience.
After all, as the parent or caregiver of an autistic child, isn’t prior planning and extra love and care what you’re best at?
I just want to give a quick thank you to Sue Ellen Miller: Special Needs Assistant, Dr James, Knight: DDS, and the many parents and family members of autistic children who assisted me with writing this article by sharing their personal experience and tips on what has worked for them in the past. You’re all special people.
