5 minute read
Introduction: Pediatric Patients, Parenting and the Pandemic: Caring for Children in Modern Times
Sharine V. Thenard, DDS, MS, Guest Editor
Sharine V. Thenard, DDS, MS, is a practicing pediatric dentist in the Bay Area. She earned her DDS from the University of California, San Francisco, and completed her MS degree and certificate in pediatric dentistry at The Ohio State University and Columbus Children’s Hospital (now Nationwide Children’s Hospital). Dr. Thenard has served as past president of the California Society of Pediatric Dentistry and the Alameda County Dental Society and as trustee of the California Dental Association and currently serves on the TDIC/TDICIS board. She is a diplomate of the American Board of Pediatric Dentistry and a fellow of the American Academy of Pediatric Dentistry and American College of Dentists. Conflict of Interest Disclosure: None reported.
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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 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 parentchild dynamic is vital in the delivery of person-centered dental care to the child, so too is the understanding of 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 patient-centered 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 Dentistry and many other dental practices in California now use teledentistry in their care models.
Professionals who care for kids must be aware that the underlying circumstances and stressors that manifest as behaviors for both patient and parent often carry over into the interactions parents have with their child’s health care provider. Not surprisingly, the COVID-19 pandemic has further complicated this. I have had families come into the office over the past year and tell me that this was the first outing for their children in months. I know many parents whose children have shown behavioral changes, children who were perfectly welladjusted before who now suffer from anxiety or depression and are in therapy.
The pandemic and the resulting isolation have negatively harmed many children in ways that are being noticed now and likely in ways that will leave a lasting impact on this generation. In their article, Dr. Jessica Lee and colleagues describe the effects on child development, psychological consequences of the pandemic and the impact on dentistry for children.
Whether you are currently treating children in the dental office or trying to raise your own while keeping your mental health intact, I hope you will appreciate this issue of the Journal. It highlights how extraordinary childhood is with the complexities of cognitive, emotional and social development, all layered with parental and environmental influences and topped with an unexpected pandemic. I thank the authors who have shared their time and knowledge on these relevant topics.
It is truly a privilege to treat children. It’s difficult and at times delicate, but also delightful and so much fun. Children see the world through fresh eyes, speak the truth and find wonder in the everyday. Whether treating them in the dental chair or raising them at home, we should remember that children are indeed a gift. They deserve our attention and kindness and for us to keep trying our very best.
