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UI pediatric dentist links clinic misbehavior with parenting styles

IOWA CITY, Iowa -- The unruly child in the dentist's chair may resist treatment not because of fear but rather out of trouble responding to requests from adults. A University of Iowa College of Dentistry professor suggests that parenting styles affect preschool children's willingness to comply with dental care.

Dr. Jimmy Pinkham, UI professor and head of pediatric dentistry, contrasts contemporary children's feelings about dentistry with those held by previous generations. Though today's children are less likely to associate dental care with pain, misbehavior remains a problem in dental clinics. Pinkham attributes part of the problem to the fact that some children simply don't learn the give-and-take process of cooperation at an early age.

"The dental appointment is basically a conversation," he says, involving the dentist's need to make reasonable requests and the patient's need to respond accordingly. Pinkham describes this process in linguistic terms as the exchange of requests and promises. It relies on essential knowledge that, he argues, some children develop later today than in previous decades.

Pinkham proposes that these children mature more slowly because their parents lack established models for childrearing and make fewer requests of their children. Earlier generations, he continues, were more likely to have grown up with expectations imposed by tradition, extended family, and, in some cases, economic necessity. They grew accustomed to the exchange of requests and promises while relatively young.

"I think the importance of requests and promises was easier to teach when children were raised with a certain urgency and at least one parent in the home," Pinkham says. Today's children may be less accustomed to acting on requests than their predecessors were. Consequently, some of the behavior management techniques pioneered by pediatric dentists generations ago may not be as effective today.

Pinkham emphasizes that this relationship between parenting, linguistic maturity and child patient behavior is only a theory. He described the idea in a paper published in the September-October 1997 issue of the Journal of Dentistry for Children.

Pinkham does not fault today's parents, nor does he think their children experience long-term harm from mild delays in linguistic maturity. Most children, he says, learn their roles and responsibilities as they grow older, particularly once they enter school. They gradually abandon misbehavior in the dental clinic.

Pinkham's interest in linguistic development and child behavior stems from his role in teaching UI dental students the basics of behavior management. Of various methods used by pediatric dentists to promote treatment compliance, the most effective and accepted rely on communication. Students must understand that successful communication requires commitment and skill, Pinkham says, especially when dealing with preschool children.

"Much of pediatric dentistry involves behavioral science," Pinkham says. He notes that becoming an effective pediatric dentist requires moving beyond one's assumptions about children, especially the belief that they cannot adapt to new situations and demands.

"Childhood is now portrayed as an extraordinarily fragile time," Pinkham says. He cites accounts of children from different eras and cultures assuming responsibilities that would seem remarkable in many contexts today. Children who face fewer expectations may take more time to acquire the skills and knowledge that make them better patients, he says.