May 2019 Volume LIV Number 3


Ask the Policy Center

September 2016 Volume LI Number 5

The Challenges of Parental Presence in Treatment

The parent who says, "I am coming back into treatment with my little Lisa, but let me finish this text first," can be a major headache for pedi- atric dentists and staff. More than ever, parents insist on staying with their children during dental treatment. Recent research shows the majority of parents prefer to remain with their children during the dental visit, not just for first visits or preventive care, but for fillings, crowns, extrac- tions, and sedation procedures. Only two in five parents say they would be comfortable with the dentist unilaterally deciding about their presence in treatment.1

In other findings, pediatric dentists indicate that their approach has shifted toward increased parental presence during both exam and treatment appointments, and that they expect further increases in parental presence in the future.2 With more parents expressing a desire to be present, and pediatric dentists expressing an increasing willingness to permit parent presence,3 the question becomes: How can your practice manage the presence of parents while still protecting productivity, patient privacy, and quality of care? Here are some tips for encouraging parents to stay in reception during certain procedures, helping parents promote a more successful visit if they accompany their children, and coping with parents who come armed with cell phones or cameras to "make a memory" of the appointment.

Encouraging Parents to Spend More Time in Reception

Rather than saying "Our office policy is to ask parents to stay in the waiting room," or "Children behave better when their parents are absent," here are some positive messages to encourage parents to relax in reception.

• If we work with your daughter Isabelle directly, we focus more on her and make it her special time. We build a positive relation- ship with her right away, and help her feel comfortable and confident about dental treatment.

• Children come first in our office! We invite children to come back to treatment on their own so we can devote full attention to them during the dental appointment. I will tell you all about how well Nathan did right after the visit.

• Allow us to get Chloe settled, then feel free to come back and check on her as often as you like.

• We find when a child is in an unfamiliar setting, they look to the parent for rescue. If they are not rescued, they become upset with the parent, and then with us. We wouldn’t want to see than happen with you and Andy.

• Children know their parents very well. They are quick to be- come concerned at even the slightest amount of tension you may show during the visit. That’s why we find many children have a smoother experience when they come back on their own.

Helping Parents Promote a Successful Visit

In a number of cases, having parents present can be an advantage, especially in new patient exams, emergency visits, and treating very young and special needs patients. Here are tips on helping parents help you, your staff, and their child have a more successful visit.

• Provide parent education materials in advance on how to pre- pare their child for a dental visit.

• Keep parents busy. Offer a tour of the office or ask them to review materials during the visit.

• Put the parent’s chair out of the child’s line of sight and as far away from the action as possible.

• Let parents know that if they talk, move or touch their child, the child may sense the parent’s anxiety and find the visit more stressful. • Advise parents that they may be asked to help with the visit, and to do so only if asked.

• Recognize that your office may differ from parental expectations. Parents typically accompany their children into such health care settings as the pediatrician’s office and are expected to physically assist with care.

Coping with Parents Attached to Their Phones

A number of parents in your practice don’t think twice about coming back into treatment and talking on their cell phones. Post a sign in the office stating, "To protect the comfort and privacy of our patients, cell phone use is not permitted." Another option is a sign that reads, "During the appointment, we kindly request that you refrain from cell phone use," or simply, "No cell phones allowed in the clinical area."

If a parent starts talking on a cell phone anyway, your practice staff should be instructed to politely say, "My apologies, but we ask all visitors to our practice to refrain from cell phone use in the office (or the clinical area). If you would like to take your call outside, I will be sure to come get you if the doctor has any questions for you."

Even more disquieting are the parents who want to film the visit or take their child’s photo in the treatment area. In the September 2015 Issue of PDT, Litch’s Law Log details solid reasons for a "no video or photo" policy for your office, including potential HIPAA violations and risk management concerns. (To review the article, visit http://

To keep parents informed of your policy, post a sign in the office and include a notice on your practice website stating, "To protect the privacy of our patients and staff, we do not allow photography (video or otherwise) on the premises." If a parent starts to take pictures or video in spite of the information posted, your team members might say, "I’m sorry, Mrs. Anderson, but we cannot allow photos or film to be taken in the office."

If a parents asks for an explanation of the policy, your team mem- ber might say, "We are required by law to protect the privacy of all our patients and our staff," or "Because our office is covered under HIPAA regulations, we are required by federal law to protect the privacy of health information for all the patients in our practice."

For the parents (or doting grandparents) who are especially disap- pointed with the "no photo" policy, you could provide an alternative. Your staff might offer to take a photo of the child and family mem- ber in a location in the reception area specifically designated for the purpose. For example, "How nice that you want a memory of Sophie’s visit with us. Please come with me to the special photo corner. Do you think Sophie would rather hold the bear or the giant toothbrush?"

With artful, positive communication, parents who stay during dental treatment don’t have to be a headache for you and your team. In fact, when parents watch you relate effectively to their child, it can be an excellent marketing opportunity for your practice.

1 Shroff S, Hughes C, Mobley C. Attitudes and preferences of parents about being present in the dental operatory. Pediatric Dentistry. 2015; 37(1):51-55.
2 Marcum B, Turner C, Courts F. Pediatric dentists’ attitudes regarding parental presence during dental procedures. Pediatric Dentistry. 1995;17(7):432-438.
3 Nathan JE, Rayman MS, Golden BE, Vargas KG. Discretionary parental presence in the dental operatory: A survey of pediatric dentists and parents. Pediatr Neonatal Nurs Open J. 2015; 2(2):50-61.

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