We are aware that getting your child ready for a dental appointment can be quite difficult, especially if they suffer from Pathological Demand Avoidance (PDA). It’s natural to worry about your child’s behaviour in a dental office. Today, our experienced Brisbane dentist aims to provide you with useful guidance to ease your child’s anxiety about dental visits, focusing on dental treatment for children with Pathological Demand Avoidance.

Pathological Demand Avoidance

Let us tell you a little about what children with PDA are dealing with. Children with Pathological Demand Avoidance (PDA) find even everyday tasks overwhelming. They often struggle with demands or requests, even if they are very simple. Children with PDA can get extremely anxious if they feel they are being pressured to do something, even if it’s something they enjoy.

This feeling of becoming overwhelmed can lead to behaviours like avoiding tasks, experiencing meltdowns, or needing to be in control of situations.  It’s important to understand the challenges these children are dealing with and know that they aren’t trying to be difficult—they’re just trying to cope in the best way they know how.

Unique Challenges PDA Presents in Dental Care

Dental settings can trigger intense feelings of anxiety and fear for several individuals. Children with Pathological Demand Avoidance (PDA) often face unique challenges when it comes to visiting the dentist.

Anxiety and Fear

For children with PDA, the dentist’s office can be a source of significant anxiety. The unfamiliar sounds, smells, and sights can be overwhelming and lead to heightened fear. Even the anticipation of the dentist visit can cause them distress and make it difficult for them to feel calm or safe. The fear and anxiety they experience can result in resistance to even basic dental procedures. Dentists who are familiar with the challenges these children are dealing with know that they should approach their care with patience and understanding.

Control and Compliance

Children with PDA can find it difficult to follow rules, especially when they feel pressured. In a dental setting, these children may refuse to follow instructions or cooperate with the dentist. Their need to feel in control may cause them to avoid tasks, engage in negotiation, or openly refuse to obey rules or orders. Creating an environment where the child feels safe, in control, and respected can help them feel more secure and willing to cooperate with the dentist.

Communication Difficulties

Communication can be a significant challenge for children with PDA, especially if they are in stressful situations. They may find it difficult to express their fears or needs clearly, which can lead to frustration and misunderstandings. Their

inability to communicate effectively may make it challenging for the dentist to assess the child’s comfort level or address their concerns effectively.

Talking to the child kindly and clearly while showing you understand their feelings helps build trust and makes the dental visit go smoother.

Sensory Sensitivities

Because of heightened sensory sensitivities, dental visits can be overwhelming for children with Pathological Demand Avoidance. The bright lights, the sound of the drill, or even the feeling of dental tools in their mouth can be too much for these children to handle. These sensitivities can trigger strong reactions, such as crying, covering their ears, or refusing treatment. Minimising sensory input and creating a more comfortable environment can help reduce these reactions and make the visit more manageable for the child.

Need for Specialised Care

Children with PDA often face unique challenges, which is why they require specialised care during dental appointments. Since standard approaches may not work, adjustments are needed to meet their specific needs. The adaptations may include longer appointment times, more breaks, or the use of non-traditional communication methods. Our dentists will work closely with parents and caregivers to develop a personalised care plan and provide the best possible support for children with special needs.

Emotional Toll on Parents

Caring for a child with PDA can be a real challenge for parents, especially during dental appointments. Seeing their child deal with anxiety and fear can be very upsetting, and not knowing how the visit will turn out makes the stress even worse. Many parents feel overwhelmed and may even avoid scheduling dental appointments due to these concerns. Offering empathy, support, and practical solutions can make a world of difference for these families and can help them feel more confident in managing their child’s dental care.

Preparing Your Child with PDA for a Dental Visit

Preparing your child with Pathological Demand Avoidance (PDA) for a dental visit can feel like a big task, but with a little care and planning, it can go much smoother. Here are some tips that might help:

• Talk About It Early: Let your child know about the visit a few days ahead, but keep it casual. Say something like, “We’re going to see a friend who helps us keep our teeth strong.” Keeping it light can help reduce their anxiety.
• Let Them Take Their Comfort: Whether it’s a favourite toy, a blanket, or even a pair of headphones, let your child bring something that makes them feel safe. These small comforts can make a big difference.
• Practice What to Expect: If possible, play out the visit at home. You can pretend to be the dentist and show how they’ll look at teeth with a little mirror. This way, your child knows what to expect and feels more in control.
• Stay Calm Together: Show your child some deep breathing or simple relaxation techniques that you can do together. Practice these a few times before the visit so they know how to calm themselves if they start feeling overwhelmed.

Remember, it’s okay if things don’t go perfectly. The most important thing is that your child feels supported and knows you’re there with them every step of the way.

Strategies Dentists Use to Help Manage Children’s Anxiety During Dental Procedures

When a child with Pathological Demand Avoidance (PDA) visits the kids’ dentist, anxiety can be a significant challenge. Dentists understand this and use several strategies to help make the experience as calm and comfortable as possible:

• Gentle Communication: Dentists take time to explain each step of the process in a calm, friendly manner. They use simple, clear language that a child can easily understand, helping to reduce fear and build trust. By speaking slowly and avoiding complex words, they make sure the child doesn’t feel overwhelmed.
• Allowing Control: Many dentists give children choices whenever possible, like letting them decide the order of the procedures or picking a flavour of toothpaste. This helps the child feel more in control, which can significantly reduce their anxiety.
• Use of Distraction Techniques: Dentists often use distraction to keep the child’s mind off the procedure. This can be as simple as playing their favourite music, showing them a video, or even letting them hold a small toy during the treatment. Distractions help to make the experience less stressful and more bearable.
• Creating a Calm Environment: The dental environment itself can make a big difference. Many dentists dim the lights, reduce noise, and even offer sunglasses to shield the bright lights used during exams. A calm, quiet space can help the child feel more at ease and less anxious.

Creating a PDA-Friendly Dental Environment

A sensory-friendly and low-demand environment can make all the difference in helping children with PDAs feel more comfortable and less nervous.

• Soft Lighting and Quiet Spaces: Bright lights and loud noises can be overwhelming for children with PDA. Dental clinics can dim the lights in the exam room and provide a quiet space away from the busy waiting area. This helps reduce sensory overload and creates a calmer atmosphere.
• Flexible Appointment Scheduling: Scheduling appointments during quieter times of the day can help minimise stress. Some dental clinics schedule longer appointments so the child does not feel rushed and can take breaks when needed. This flexibility allows the child to feel more in control and less pressured.
• Personal Comfort Items: Letting children bring their favourite toy or blanket or wear noise-cancelling headphones can help them feel more comfortable during the visit. These familiar items can help soothe their anxiety and make the dental environment feel safer.
• Clear and Simple Communication: Dentists and staff can use clear, simple language to explain what’s happening in a way the child can easily understand. Breaking down each step of the visit and offering choices can help the child feel more involved and less threatened by the experience.

Personalised Dental Care Plans for Children with PDA

Every child is unique, and for those with Pathological Demand Avoidance (PDA), a one-size-fits-all approach simply doesn’t work. Creating a personalised dental care plan is crucial in ensuring that your child feels understood, safe, and supported during their visits.

• Listening to the Family: The best starting point for a personalised care plan is listening to you, the parents. You know your child better than anyone else—what triggers their anxiety, what helps them calm down, and what they absolutely cannot tolerate. By working closely with you, the dentist can tailor the experience to meet your child’s specific needs, making the visit less stressful.
• Gradual Introduction to Care: Some kids with PDA might need to take things slowly when it comes to dental care. This could start with just visiting the clinic to meet the staff and look around without any treatment. Gradually, as your child becomes more comfortable, the dentist can slowly introduce more aspects of dental care.
• Flexible Treatment Options: A personalised plan also means being flexible with treatment options. If your child finds it difficult to sit through an entire procedure, the dentist may be able to break it into smaller, more manageable sessions. This way, your child doesn’t feel overwhelmed, and each visit can be a more positive experience.

Personalised dental care plans recognise that every child with PDA is different, and they focus on making sure each visit is as comfortable and positive as possible.

Dealing with Meltdowns and Refusals During Dental Appointments

Watching your child struggle during a dental visit can be incredibly tough. Meltdowns and refusals are common for children with Pathological Demand Avoidance (PDA), and it’s important to handle these moments with care, patience, and empathy. Here are some ways to make the experience a bit easier for both you and your child:

• Stay Calm and Reassuring: When a meltdown happens, your calm presence can make a world of difference. Speak softly, reassure your child that they are safe, and let them know it’s okay to feel upset. Sometimes, just hearing your voice and knowing you’re there can help them start to settle.
• Take Breaks When Needed: If your child is overwhelmed, it’s perfectly fine to pause the appointment. Let them take a break in a quiet space, away from the chair and the bright lights. Taking a break from the procedure can give the child a moment to regain their sense of control and calm down before continuing.
• Use Familiar Comfort Items: Let your child hold a favourite toy, wear headphones, or use a weighted blanket during the appointment. These small comforts can help them feel more secure and may reduce their stress.
• Work as a Team: Communicate with your dentist beforehand about potential triggers and strategies that work best for your child. Together, you can develop a plan that includes gentle techniques, such as distraction or a slow, step-by-step approach to care.

Oral Hygiene Tips for Children with PDA For Maintaining Oral Health At Home

Sticking to daily oral care can be hard for children with Pathological Demand Avoidance (PDA). Brushing teeth every day might feel too much or even scary for them and cause them to resist. Here are some gentle ways to make brushing a bit easier and more manageable:

• Make Brushing a Choice: You can give your child a sense of control by offering them choices. Let them pick their toothbrush or toothpaste flavour. You can even let them decide when to brush, for example, whether it’s before or after a favourite activity. These small decisions can help them feel more in control and less resistant.
• Turn Brushing into a Game: You can make brushing fun by turning it into a game. Use a timer and challenge your child to brush until the timer goes off, or sing a favourite song while brushing. You might also try a reward system, where each time they brush their teeth successfully, they earn a sticker or a point toward a small treat.
• Brush Together: Brushing teeth can sometimes feel less scary when it is done together. Brush your teeth at the same time as your child, showing them how you do it and offering encouragement along the way. Your presence can make the task feel more routine and less stressful.
• Be Patient and Flexible: If your child is having a tough day and refuses to brush, it’s okay to take a break. Forcing them to brush their teeth when they are not cooperative can lead to more resistance. Instead, try again later or find a different approach that works better at the moment. The goal is to keep the routine positive and stress-free.

Building Long-Term Dental Health Strategies

Building good dental habits for your child takes time, especially if they have PDA. Regular dental visits and seeing the same dentist consistently can help your child feel more at ease over time.

• Start with Small Steps: Start with short, low-stress visits to the dentist. These could be just a quick look around the clinic or sitting in the dental chair without any treatment. As your child gets used to the environment, you can slowly add more parts to the dental care routine.
• Keep a Consistent Routine: Seeing the same dentist regularly helps your child get used to the dental visits and build trust. Your child will know what to expect, and the dentist will understand your child’s needs better.
• Use Positive Reinforcement: Celebrate small victories, like a successful check-up or a calm visit, with praise or a small reward. Positive reinforcement helps your child link dental visits with positive feelings, making them more likely to cooperate next time.
• Stay Patient and Understanding: Building cooperation takes time, and it’s normal to have setbacks. It’s important to be patient and supportive and to focus on progress, not perfection. Every small step is a win.

Frequently Asked Questions: Ask Our Brisbane Paediatric Dentist

Dr Elli, our Brisbane Paediatric Dentist, is here today to provide realistic answers to some of the questions and concerns parents have had about providing oral healthcare for children with Pathological Demand Avoidance.