The roles of requests and promises in child patient management

It is typical for some to assess the misbehavior of children in the dental appointment to be exclusively for reasons of fear. Such an assessment is offered in this paper to be naive. Fear certainly can be a predictor of avoidance behavior, but avoidance behaviors are often found in child dental patients who are remarkably well acquainted with dentistry and who know that the procedures that lay ahead for them are in no way painful or fearful at all. In the case of a recalcitrant child patient, the mechanism by which human beings get things done with other human beings, requests and promises, does not work because of the child's aversion to adult authority. It is submitted that there are children who are poor promisers, because of a background discourse that they have with themselves that makes it difficult for them to interface effectively, i.e. by making effective promises, with other people. Since the dentist is a requester and the dental appointment works by requests, these children are reliably problem patients. They cannot make commitments to cooperate. Four types of children have been described who by a misdirected goal of their childhood, which they have absorbed early, are reliable predictors of misbehavior and avoidance behavior during dental appointments. The internalized goal makes cooperation with a requesting adult difficult. This fact is often seen perhaps in the dental office first, because in our society today very few requests are made of our preschool children.(ABSTRACT TRUNCATED AT 250 WORDS)