Pediatric Dentistry, Parents, and Spoiled Kids by Jeanette MacLean, DDS

Let me be honest: After more than 10 years in pediatric dentistry, I find the kids are not my challenge—it's their parents. There … I said it.

Don't get me wrong. The majority of parents I see on a daily basis are delightful and I truly enjoy chatting with them at their children's visits, but a growing percentage of demanding parents tests my patience. The two greatest challenges I face are the parents who overindulge their children, and the know-it-all parents. However, recognizing and managing these "helicopter" or "snowplow" parents can prove to be a fun and rewarding experience. In fact, once you win them over, they often become the greatest advocates of your practice.

Let's look at how today's culture contributes to these perilous parenting trends.

The overindulger
Nowadays you don't have to be wealthy to have an overindulged child. In many ways, our overscheduled lives and complicated family dynamics have bred a culture of guilt-ridden parents. Contributing factors for parents who overindulge their little ones may include common stressors such as divorce, grandparents who serve as primary caregivers, or both parents working full-time jobs.

As a working mom of two young children, I am guilty of this parenting pitfall. Too many treats, too many toys—why do we do it? While I cannot speak for everyone, I know that I feel guilt from the long hours I put in at the practice.

After a long, hard day managing other people's children at my office, the last thing I feel like doing is wrestling my 3-year-old to get her to brush her teeth. I just want to come home and relax—I want my kids to be happy—I don't want conflict. But having seen the perils of the tiny dictators at my office, I quickly snap out of it, put on my mommy pants and lay down the law. The problem is the ever-growing number of parents and guardians who fail to be the parent and find it far easier to be their child's friend. Because there is very little discipline for bad behavior, often the child is left with a sense of entitlement.

Another cultural phenomenon that contributes to the overindulged child is the new normal of parents striving for "Pinterest perfection." In an ongoing attempt to not just keep up with the Joneses, but rather one-up the Joneses, every little life event is celebrated, documented and chronicled online for all the world to see. There is a ribbon, a trophy, or certificate of participation for all of life's precious moments. Even my 5-year-old son, who was more interested in his soccer league's postgame snack and never scored a goal the entire season, still got a trophy from his team. The trouble is, when we try to get these little darlings to cooperate for dental treatment, they're no longer impressed by a 25-cent prize from our treasure tower.

To further complicate the matter, their parents often have unrealistic expectations of our abilities. They can't even manage to brush and floss their 5-year-old's teeth, but we're supposed to use our Jedi mind power to get the child to sit perfectly still for a pulpotomy and stainless-steel crown.

Here's where clear communication is key. Level with the parent and explain what you can and cannot do. This is part of your informed consent. School-age children may still be manageable with tell/show/do and nitrous oxide, and in fact, you may be surprised at how many of these kids actually enjoy and crave a little structure. You and your assistant have to set the ground rules, right out of the gate. Let your young patients know you are the boss in your office, clearly state your goals for their visit and expectations for their behavior, and yes, dangle that carrot—the prize and sticker they'll get when they are done.

There will be some patients for whom this simply will not work, such as preschool-age or particularly defiant or fearful children. Extensive dental care may require oral conscious sedation, intravenous sedation or even general anesthesia. It is important to know your limits and know when to refer to a specialist.

The know-it-all parent
The days of "doctor knows best" are long gone. Nowadays it's more like "my Facebook friend's cousin's mommy blog knows best." You've gotta love explaining a treatment plan to a parent only to have her retort, "I'll have to research that." Yes, because a night on Google somehow makes her more knowledgeable than her board-certified pediatric dentist. Comments like these early in my dental career really got under my skin. I actually felt downright insulted. It wasn't until I became a parent myself that I realized that these parents are not trying to offend us; they simply want what's best for their child. Sometimes they think that only they know what's best for their child.

Many couples are now waiting until later in life to marry, often putting their education and career first. They're waiting until they're older and more financially secure to have their first child. When that perfect time finally comes, many have already spent years planning the perfect nursery and the perfect name, and researching the best stroller, the most ergonomic carrier, and the most eco-friendly organic sustainable diaper. They've read every maternity and parenting book cover to cover, they've painstakingly planned and prepared for this moment for years, they've scheduled their IVF and their C-section, and now they're going to tell you how to do their child's filling.

Right or wrong, thanks to the Internet and social media, dentists can no longer hide behind the sanctity of their doctorate. Some parents truly believe they know enough to engage the dentist in treatment options.

Sometimes parents are know-it-alls by association. You've seen these types: "My mom is a nurse," or "My second cousin once removed is an anesthesiologist." These people have filled your patient's parents' heads with questions and concerns. You wish you could say, "Well, since they know so much about dentistry, why don't you have them do little Johnny's extraction?" But you can't. This is when you need to stop, take a deep breath and remember one very important fact: they are sitting in your office. They've already picked you. You win. Be confident, offer them reassurance, acknowledge their concern and indulge their extra questions. Know-it-all parents want to be heard; they want to be involved in the decision-making process. That's easy. Handouts, brochures, models, great online links and simply the time and attention from you and your staff can easily do the trick.

These parents may be needy at first, but with a little hand-holding and reassurance, a trusting doctor-parent- patient relationship blossoms. The seal of approval from these picky parents can be more valuable than any paid advertisement, as it often results in new-patient referrals that are, ultimately, a dentist's own best reward for good behavior.

Dr. Jeanette MacLean is a private-practice pediatric dentist and owner at Affiliated Children’s Dental Specialists in Glendale, Arizona. She is a diplomate of the American Board of Pediatric Dentistry and her clinical research has been published in Pediatric Dentistry, the official publication of the American Academy of Pediatric Dentistry. Visit for more information.

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