Children's perspectives on health and the body

Question 1

Seen but not heard

Answer 1

Systematic review of child dental literature from 2000-2005
Four main categories:
-children as objects of research
-proxies used on behalf of children
-children as subjects of research with some involvement
-children as active participants

Question 2

First pass: exclusion criteria

Answer 2

Reports before 2000
Studies with participants over 16
Studies with no primary data
Articles reporting in vitro studies
Conference proceedings
Articles that did not have children and aspects of their oral health as their main topic

Question 3

Seen but not heard: how many papers with children as active pariticipants (children involved in research process)

Answer 3

2 (0.1%)

Question 4

Seen but not heard: how many papers with children as active participant (children’s own accounts)

Answer 4

6 (0.2%)

Question 5

Philosophical views of the child: Hobbes

Answer 5

Believed in original sin, so children are born into sin (Nativist theory - natural state of child)

Question 6

Philosophical views of the child: rousseau

Answer 6

Children are inherently good but society corrupts them (Nativist theory - natural state)

Question 7

Philosophical views of the child: Locke

Answer 7

Children as blank slates or ‘tabula rasa’ (empirical view - social cultural process)

Question 8

Philosophical views of the child: Kant

Answer 8

Children born with mental structures but develop in interaction with their environment (transactional view)

Question 9

Psychological views of the child

Answer 9

Freud - the unconscious (quite nativist)
Piaget - the naturally developing child (similar to Kant, dominant view in society)
-child is incomplete adult so unable to make decisions until they grow older

Question 10

Research with Children (Marshman and Hall, 2008): why is this important?

Answer 10

Children’s Rights Movement
UK Children’s National Service Framework
Scotland - ‘child friendly’ services
We need to generate a more child centred approach to oral health

Question 11

UK Children’s National Service Framework

Answer 11

Recognition that adults should listen to children, value their perspective and take their views into account in delivery and evaluation of services

Question 12

Power imbalance

Answer 12

Language use: children can communicate they just do it differently
Setting: consider bias and power in schools and clinics
Analysis: don’t impose researchers view
Quality of data: trust the children’s accounts
Ethical concerns: there are lots of issues here

Question 13

Research techniques

Answer 13

Child centred questionnaires can be used e.g. Child Perceptions Questionnaires and the Child Oral Impacts on Daily Performance
Questionnaires can use images to aid children
Timeline exercises
Life grids
Drawings
Vignettes - imagine your best friend was just diagnosed with … What would you say to them?

Question 14

Px experience central to good quality care

Answer 14

Department of Health policy highlighted importance of improving px’s experience
NICE published quality standard on px experience:
-knowing px as individual
-tailoring healthcare for each px
-continuing care and relationsihps
-enabling pxs to actively participate in their care
Requirement for care to also be clinically and cost-effective

Question 15

Key features of dental care reforms capturing and improving

Answer 15

Px experience

Clinical and px outcomes

Question 16

Council of Europe’s ‘Guidelines on Child-Friendly Health’

Answer 16

Advocates children’s rights to healthcare
Stresses need to respect and protect children’s rights in healthcare
Children to have views taken into account in all decisions affecting them

Question 17

Key areas of child oral health to improve experiences and outcomes

Answer 17

Dental caries
Malocclusion
Defects of enamel
Trauma
Dental anxiety
Cleft lip and palate

Question 18

How common is dental anxiety in children

Answer 18

Just over half report some level

1 in 10 reporting high levels

Question 19

How has dental anxiety in children been managed traditionally

Answer 19

Pharmacological techniques including inhalation sedation and general anaesthesia
Evidence: does not reduce anxiety
Costly

Question 20

What is CBT?

Answer 20

Talking therapy
Helps people address unhelpful thinking patterns and ways of responding
Phychologist-led and self-help CBT are recommended by NICE for treatment of depression, anxiety and phobias

Question 21

Five Areas approach to CBT

Answer 21

Situational factors unhelpful thoughts altered feelings unhelpful behaviours altered physical symptoms

Question 22

Development of self-help CBT guide

Answer 22

Development guided by Five Areas model of CBT
Used child-centred approach
-dentally anxious children 9-16 years, parents and professionals involved
-participants shown drafts of guide and modifications made on feedback
-accompanying resources developed for parents and dental team members

Question 23

Key features of the child guides

Answer 23

1) Challenge unhelpful thoughts
- normalises dental anxiety
- provide info
2) Enhance control
- message to dentist
- stop signal contract
3) Reflect and plan reward

Question 24

Evaluation of study

Answer 24

Worked quantitatively
Qualitatively:
-< anxiety, > confidence
->understanding
-overcoming barriers