How to Manage An Apprehensive Child Before and During a Dental Visit

By Dr. Jane Soxman

Apprehensive children may create many concerns and anxiety for parents, dentists and staff. The following recommendations offer some tips for behavior guidance.

  • Parents should not offer presents or rewards for good behavior prior to the visit. This may prompt additional fear that something really difficult is about to occur. A surprise to be given just after the visit may be more appropriate.  Do not tell a child to be brave or that nothing will hurt.  The idea that dental care requires bravery or that pain may be involved may have never occurred to the child.  Positive preparation may include a story about going to the dentist, placing the child in a reclining chair to experience the sensation of moving backward and brushing with a battery powered spin brush to experience a sensation similar to the rubber cup used to clean teeth. Minimizing comments or explanation by parents is advisable. Parents may unintentionally create more anxiety in the child with their silent cues, especially if there is any parental fear regarding dental visits.
  • Only one parent should accompany the child for the visit and that parent should be the one who is more comfortable with dental treatment.  Consistency is very important. The dentist, parent and child function as a team.  If the visit went well with Dad, he should be the parent who returns for subsequent visits.
  • Morning appointments are always recommended for apprehensive children. The children are more rested in the morning and morning appointments usually have less waiting time. Also, the child may worry about the appointment throughout the school day and being tired after school will result in reduced coping skills.
  • In the reception room, the parent should sit closely beside the young child, reading a story. This not only provides distraction but also places the child in a more relaxed frame of mind. Free play should be avoided.
  • Parents may share their primary concerns regarding their child’s anxiety or fears with the dentist or staff prior to taking the child to the examination area. Some advice or reassurance may help to ease the parent’s concerns and the child may be eased into the dental chair with a slightly different approach. Parents must understand the child’s behavior may impose limitations on dental treatment, but most apprehensive children can be treated with empathetic guidance.
  • Parents should not attempt to describe the events of a visit for restorations (fillings).  If the child asks, the response should be that the dentist or his helper will carefully explain everything planned for the visit. Parental tone of voice or body language could accidentally create a sense of fear or apprehension in an unsuspecting child.  The dentist should determine how much and what should be said prior to the visit. The child’s perceptions and level of anxiety are strongly influenced by his parents, particularly by Mom.
  • If local anesthesia (a shot to numb the teeth) is to be used, this should never be discussed prior to the appointment. “Shots” are universally the most feared aspect of the dental visit for children, however most often injections can be performed painlessly, without the child being aware of the occurrence. A child who comes to the appointment already intensely worried about the “shot” is much more difficult to calm. Studies have shown that anxiety may reduce the efficacy of the local anesthetic. Because some procedures may be performed without local anesthesia, parents should not assume that an injection is necessary.
  • Expectations of a child’s behavior must be age-appropriate. By four years of age, an emotionally and physically healthy child should be able to separate from the parent for an examination and possibly treatment. Opinions vary amongst dentists regarding parental presence for treatment.  Parents should agree with the dentist’s philosophy regarding parental presence for treatment and this should be discussed and clearly understood prior to the visit.
  • Most children under four years of age are not yet emotionally capable of separating for treatment, and a parent should be present. Some parents and children over age four insist on parental presence.  If the parent is present for treatment, he or she must be the dentist’s silent partner.  The parent must remain calm and quiet. The mere presence of the parent provides support for the child. Children are very aware of silent cues from parents; body posture and facial expressions may speak volumes to a child. The dentist must give the child undivided attention and the parent should not divide the child’s attention between herself and the dentist.
  • Prior to reclining the dental chair, the dentist should place his or her hand on the child’s shoulder, while informing the child that the chair is going to move backward. Both the dentist and staff should ask the child, “Do you know my name?” Make sure the child has been re-introduced with a smile and comforting attitude.
  • Voices should be low and soft, never attempting to speak louder than the child’s crying. The parent (only one present) may need to be reminded of this. A small hand mirror may offer good distraction after the local anesthesia has been administered. The dentist may count backward, tell a story, sing a song or ask about pets, requesting a “yes” with the child showing one finger or  “no” with two fingers. The dentist and assistant can guess what kind of pet, boy or girl, color and name. Always very distracting, humorous and incredibly successful for calming an upset child after treatment has begun.  Just an occasional pat on the shoulder may be adequate for some children, offering some non-verbal assurance from the dentist.
  • If a child is crying, listen to the sound of the crying. Compensatory crying does not change in pitch and is a means for the child to cope.  The parent should not become the “court of appeals”, permitting the child to delay treatment by reaching for one more hug or to tell the parent one more thing.  The dentist must direct the treatment, not the child.
  • If unable to gain the child’s cooperation with parental presence, the parent may be asked to leave the operatory. This would occur only if the child is four years of age or older. The door to the operatory is left open so the parent can check on the child.
  • Parental love must permit age-appropriate independence.  A parent’s permitting his or her child to undergo treatment without being present sends two messages. First, “It is ok. I really do not need to be right beside you for this.” Second, “You Can Do It! I have confidence in you.”  This child has been given a very positive message and a sense of empowerment.
  • Some parents prefer not to be present, but if a child becomes extremely upset or borderline hysterical during the procedure, the parent should be present to possibly assist in calming the child and to be assured that the child is not being harmed.
  • Age-appropriate expectations, individual temperament, previous experiences and social influences must be considered for each child. Parents also should be guided with insight and recommendations to gain an understanding of the dentist’s treatment goals and the limitations imposed by behavior. This preparation provides a positive influence for not only the parent and child, but also the dentist and staff, assuring a less stressful and more successful visit for all.


Dr. Soxman is a diplomat of the American Board of Pediatric Dentistry, a Fellow in the American College of Dentists, on the board of advisers for General Dentistry and is a seminar instructor for two General Practice Residencies.

Dr. Soxman presented at the 2012 Oregon Dental Conference and is from Pennsylvania.



3 Responses to “How to Manage An Apprehensive Child Before and During a Dental Visit”

  1. Thank you for the auspicious writeup. It in fact was a amusement account it. Look advanced to more added agreeable from you! However, how can we communicate?

    • thet0742 says:

      Thanks Natalia! Every week we have a professional dentist write a guest post for our blog. If you have a specific question please let us know and I can forward it on to that week’s author.

  2. Hi would you mind sharing which blog platform you’re using? I’m planning to start my own blog soon but I’m having a hard time deciding between BlogEngine/Wordpress/B2evolution and Drupal. The reason I ask is because your design seems different then most blogs and I’m looking for something unique. P.S My apologies for being off-topic but I had to ask!

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