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/

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