|Year : 2018 | Volume
| Issue : 4 | Page : 407-409
Does attachment profiles influence child's behavior in pediatric dental clinic?
S VS G Nirmala1, Rupak Kumar Dasaraju2, Nuvvula Sivakumar1
1 Departments of Paedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
2 Departments of Pedodontics and Preventive Dentistry, Priyadarshani Dental College and Hospital, Tiruvallur, Tamil Nadu, India
|Date of Web Publication||16-Oct-2018|
S VS G Nirmala
Department of Paedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore - 524 003, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Although it was believed that attachment was due to the food provided by the parent figure, later it was proved that attachment is because the child considers parent figure as secure base. Hence, when a child feels distressed in dental operatory, the type of attachment pattern will determine the behavior of a child. This, in turn, could determine the weather parental presence is needed or not in dental operatory. Hence, attachment patterns could affect the quality of dental treatment delivered.
Keywords: Attachment, behavior, children, dental operatory, mother
|How to cite this article:|
G Nirmala S V, Dasaraju RK, Sivakumar N. Does attachment profiles influence child's behavior in pediatric dental clinic?. J Indian Soc Pedod Prev Dent 2018;36:407-9
|How to cite this URL:|
G Nirmala S V, Dasaraju RK, Sivakumar N. Does attachment profiles influence child's behavior in pediatric dental clinic?. J Indian Soc Pedod Prev Dent [serial online] 2018 [cited 2019 Apr 19];36:407-9. Available from: http://www.jisppd.com/text.asp?2018/36/4/407/243445
| Introduction|| |
Attachment is the tendency of infants and young children to rely on a parent figure for comfort and support when frightened stressed or ill. Attachment bond is long-term stable tendency to seek out a selected parent figure in terms of stress. Although attachment and bonding were synonymously used, they are not the same. “Bonding” concept was developed by Klaus and Kennell that implies parent-child 'bonding' which depends on skin-to-skin contact. This concept of “bonding” was proven to be erroneous and to have nothing to do with attachment.
Parents' sensitivity and response to a child's attachment signals are determinant of attachment security., However, genetic factors have limited role in the development of attachment in infants and preschooler. There are two main theories explaining attachment.
Two main theories
- Learning/behaviorist theory, e.g., Dollard and Miller (1950) – Children bond to mother due to feeding, combine classic conditioning (associate feeder with comfort of being fed), and operant conditioning (repeat behavior in order to get things they want
- Evolutionary theory of attachment: e.g., Bowlby, Harlow, and Lorenz imprinting theory – Children bonding to mother are due to safety and security.
Attachment influence on parental presence in operatory
The parental presence in the dental operatory during a child's treatment and influence on behavior of children is still a debatable issue. Many demonstrated that a child's behavior is unaffected by the parental presence or absence in the dental operatory; however, the presence of mothers proved to be beneficial.
When given a choice, parents wish to be present in the dental operatory, it is due to the attachment of children to their parents, and the same attachment even makes the child to seek parental presence. Peretz and Zadik done a study on 104 parents completed a questionnaire regarding their presence in the operatory. Most of the parents (70.2%) expressed a wish to be present in the operatory. Arathi and Ashwani also conducted a questionnaire study answered by 1350 parents and concluded that 78.3% of whom expressed their willingness to be present with a child during dental procedures. Crowley et al. studied the preference of parents of 8-year-old school children in Ireland in relation to accompanying their children during dental procedures and concluded that if given a choice, the majority of parents (67%) would prefer to accompany their child when receiving dental treatment. In the literature, it was showed that majority of Saudi parents studied preferred to stay with their children during treatment.
It was supported by the attachment theory of John Bowlby, which states that children seek the proximity of caregivers/parents whenever they anticipate adverse situations. John Bowlby and Mary Ainsworth work on attachment theory presented different attachment profiles. Mary Ainsworth and Wittig (1969) proposed three attachment styles based on strange situation procedure, namely “secure,” “avoidant insecure,” and “ambivalent insecure;” later Main and Solomon (1990) added the fourth style known as “disorganized insecure” styles of attachment. The characteristics of these different attachment styles were mentioned in [Table 1].
The main characteristics of attachment are proximity maintenance with caregiver, feeling a caregiver/parent as a secure base and safe heaven, showing distress when separated from parent/caregiver. These characteristics warrant the parental presence in the dental operatory when dealing with children of young age, and these characteristics may change with the age of a child and may not hold good for older children, as children of age <5 years cannot tolerate separation from the parents, due to separation anxiety and stranger anxiety. Conversely, a study reported that parental presence or absence does not affect an Iranian 5-year-old child's cooperation on the first and second dental visit (Hossien Afshar). However, in this study, the attachment characteristics were not addressed.
The pattern of attachment changes with the age of a child. Rudolph Schaffer and Peggy Emerson (1964) proposed attachment stages (depending on age) as, 4 types.
- Preattachment (0–3 months)
- Indiscriminate attachment (1 1/2–7 months)
- Discriminate attachment
- Multiple attachment.
The level of attachment of children to caregivers/parents is in turn dependent on the age of a child. Few studies report that the behavior of a child in parental presence or absence in dental operatory is dependent on age.,, Hence, the parental presence in dental operatory is determined to extend by the age of a child. However, exclusion of the parent allowed the dentist to develop an amicable relationship with the child–patient without parental interference. Dentists also argue that parental presence can be a distraction for both the child and the health-care professional and hampers delivery of quality dental care.
Handa et al. concluded that from the parent's perspective, their protective nature wants them to be with their child so that they can make their child feel safe. However, for the dentist to form a holistic bond with the patient, certain factors need to be kept in mind that define the parental attitudes for better treatment of his patient. Shaw and Routh studied 18-month-old and 5-year-old children receiving immunizations with and without the presence of their mothers and found that behavior was worse in both age groups when the mother was present.
| Conclusion|| |
Attachment of children with parents plays a role in children behavior in dental operatory which in turn determines the necessity of parental presence in dental operatory or not in children below 8 years of age. As attachment is age dependent, operator should decide upon parental presence in operatory depending on their co-operative levels.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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