Behavioral Management in
Pediatric Patients with Down Syndrome
Children and adults with Down syndrome demonstrate a wide range of cognitive
abilities and personality traits. However, many individuals with Down
syndrome may have mild or moderate levels of intellectual disability which
may influence their ability to understand instruction across various settings,
especially settings which may be very foreign to them, such as the dental/clinical
treatment arena. When combined with the communicative difficulties which
are very prevalent in this population, the pediatric patient with Down
syndrome may present a unique challenge for the dentist.
Children with Down syndrome are no different from "typical"
pediatric patients in that they respond to a calm, caring, demonstrative
approach to dental treatment. As in all patients, it is important to establish
rapport and gain trust. Children with special needs, however, typically
require more time for treatment, and thus ample time should be allotted
to perform needed care in an unhurried manner.
Some simple strategies which may prove useful for gaining cooperation
in the pediatric patient with Down syndrome are listed below.
- First discuss the child's communicative and intellectual abilities
with the parent. Determining the level of communication is imperative
to building a cooperative relationship with your patient with Down syndrome.
The parent may be able to offer valuable advice as to what motivates
their child. Investigate what types of management techniques have proven
successful in the home environment and attempt to modify these for the
dental setting.
- Find out what time of day would be best to schedule the dental appointment;
some children may be more cooperative either in the morning or afternoon.
- Make sure the entire dental team has been educated concerning the
proper attitude and treatment of patients with special needs. The continuum
of care should begin with the office receptionist and extend to the
dental assistant and the dentist.
- Praise, praise, praise! Most children respond to compliments and praise,
and children with Down syndrome are no exception. Reward good behavior
and maintain a patient and positive affect.
- Attempt to reduce distractions as much as possible. Some dentists
(including those caring for typical adults and children) have employed
music as an intervention to help patients relax. The dentist may provide
a headset or request that the parents bring one from home if this would
be a helpful option.
- Try beginning the oral examination by using only your gloved fingers,
then progress to the use of dental instruments.
- Make every effort to provide consistency in routine, staff, and location
when working with children with special needs. All patients tend to
be more cooperative in a familiar setting with familiar faces.
- DO NOT use physical restraint or sedation merely
as a convenience. There are times when these measures may prove absolutely
necessary - but this is the only time they should be used. The dentist
should always use the least restrictive technique that will allow the
patient to be treated safely.
- Include the child, whenever possible, when conversing with the parent,
rather than "talking about" the child in his or her presence.
- Remember that children with Down syndrome may experience difficulty
processing sequential information; thus break any instructions down
into succinct parts pertinent to the task at hand.
- Modeling dental treatment on an older sibling, or another cooperative
child may prove useful for some children.
NIDCR
National Institute of Dental and Craniofacial Research (2005). Behavioral
management. Practical oral care for people with Down syndrome. Retrieved
online 6/17/05 from http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/
DevelopmentalDisabilitiesAndOralHealth/PracticalOralCarefor
PeopleWithDownSyndrome.htm
Pischer,
E.S. (1997). Behavior management in dental care for the patient with
Down syndrome (Paper presented at the 6th World Congress on Down
Syndrome, October 1997). Retrieved online 6/17/05 from http://www.ds-health.com/dental.htm