PRACTICE PEDIATRIC PATIENTS, PARENTING AND THE PANDEMIC: CARING FOR CHILDREN IN MODERN TIMES When I entered my residency in the early 2000s, there was already talk among pediatric specialists about how prevalent parenting styles were changing from previous generations. More than 15 years later, the consensus is it is still happening. Being a pediatric dentist is challenging. Children are unique. They are not “little adults,” and their teeth are not just smaller versions of permanent teeth. I would say, however, that the greatest challenge in treating children is not the clinical aspect, but the behavioral and psychological aspects. Children are attached to adults, and the accompanying adult also has plenty of emotional needs that the dentist must assess and decide how to address. Parental guilt, defensiveness or denial are all emotions that any dental professional needs to deal with, along with sometimes unrealistic expectations or very prescriptive guidelines from parents. I remember one mother telling me before an operative appointment with an anxious boy: “Don’t tell him about his cavities, don’t tell him why he’s here today, don’t let him see any dental tools, don’t use nitrous … and don’t let him cry!” In addition to being a pediatric dentist, I am also a parent of three children. If there is one thing that makes a decent human being feel insecure, frustrated and at times helpless, it is being a parent. Parenting is incredibly complex, challenging and emotionally charged. I often find myself getting very frustrated with my children, while being patient with other people’s children in the office is a given. I can confidently say that many of us who are currently raising children have decided which elements of parenting we would like to replicate from our own upbringing and which we adamantly refuse to use on our own children. Many parents today take guidance from books or other parents and do their best. Parenting is happening in the context of today’s society, not in isolation and not in the society of days past. In addition to the psychological dynamic between parent or caregiver and the child, the changing nature of family structure 20
and family dynamics also impacts parent behavior and child behavior. Dr. Clarice Law and colleague’s article sheds light on understanding the parent-child dynamic to deliver person-centered dental care to children. While the nature of parenting is changing, the understanding of child development continues to deepen. I think you will find the update on childhood brain development, along with emotional and cognitive development, fascinating. In addition, the article reviews generational differences, impact on child development and new approaches to managing child behavior. Just as understanding the parent-child dynamic is vital in the delivery of person-centered dental care to the child, so too is the understanding of Photo: Image licensed by ingram image that family’s environment and beliefs. Because parents are the gatekeepers to their children’s food, activities and hygiene, they also control their health. In their article, Dr. Paul Casamassimo and colleagues give an overview of person-centered care, also known as patientcentered care (PCC), and tailoring prevention and treatment to the child and family. They explain how PCC has been used in pediatric dentistry and how it can expand the general dentist’s awareness of the greater influences of societal and environmental factors of oral health. PCC acknowledges the individual and interacting contributions of the patient, family, community and environment in disease and health maintenance. While being a dentist who provides care for children in the best of times has its share of difficulties, being a dentist who cares for kids in COVID-19 times is even more stressful. Like you, I have had to navigate how to safely deliver care during the pandemic. How do we care for patients in ways that keep everyone safe, without worsening our patients’ dental conditions, and within the confines of what is behaviorally and emotionally acceptable for children and their caregivers? Dr. Ray Stewart and co-authors describe how pediatric dentistry has experienced an increase in telehealth technology to serve children’s dental needs. Because of the pandemic, the UCSF Department of Pediatric November / December 2021
