CDA Essentials 2016 • Volume 3 • Issue 8

23 Volume 3 Issue 7 | I ssues and P eople The Goal In our practice we’ve developed a program called the Patient Guided Sensory Integration Program. It’s a framework that we alter depending on the patient’s needs and what the child is most comfortable with. Our goal is to create an environment where a child can tolerate care—just simple brushing and an examination. It doesn’t necessarily mean we can perform treatment, but we have to be able to perform a comprehensive exam to determine their needs. Some of the children I see will still end up having sedation or general anesthetic for treatment but many are able to learn to tolerate other procedures. Even children who do require alternative care can get most or all of their routine care done in the clinic. Calming environment The first thing is to have a good location in your office: a quiet area without a lot of distractions. We have a room where the child is allowed to settle for 2–5 minutes when they first come to the clinic. It has a couple of books, a bench, a mobile on the ceiling and minimal decorations on the walls. It’s fairly isolated and quiet. Pretreatment assessment The second thing we do is learn more about the child from the parent. We ask a parent to fill out a detailed questionnaire and ask, “What’s worked with your child? What hasn’t worked? How do you motivate your child? Do you use rewards or reinforcers?” We use that information to determine how we’re going to work with their child. The child is often nonverbal so it’s the parent who speaks for their child. Count and sing! I use techniques like counting to five and singing. It helps in setting up boundaries from the first visit. Most of the time, whenever my hands are on the child, I start with counting or singing to five and my hands come off by the time I get to five. We create a sense of trust, and there’s a huge element of trust with all children. It sets up a start and a finish. Most of us can tolerate something for five seconds—even if I do it fifty times, they know I’ll be stopping. Heather Coulter Jackson Heather Coulter Jackson is a registered dental hygienist who specializes in treating children with autism and other special needs—kids who usually won’t tolerate treatment in other clinics. She’s acquired her skills through considerable training, 25 years of experience and, to some extent, intuition. She spoke with CDA about what she does to successfully treat children with autism, whose impaired communication and social, behavioural and intellectual functioning can make it difficult to provide dental care. Ms. Coulter Jackson works in the pediatric dental clinic of Dr. Clive Friedman in London, Ontario. Photo (opposite page): Heather Coulter Jackson uses deep pressure on a young patient’s ears while counting to five in a singsong voice.