Assessing parent/carer motivation
Assessing parent/carer motivation and ability to take responsibility
Children are dependent on their parent/carer for maintaining their oral health through applying preventive interventions, promoting a positive attitude to oral health and for bringing the child for regular dental care. Therefore, the parent/carer’s cooperation and active participation is essential in the successful prevention and management of dental caries. Some parent/carers need support and encouragement to be able to accept responsibility for their child’s oral health. They might need additional support from other community services to achieve this. Where needs cannot be met by the dental team alone, the clinician has a responsibility to ensure that multidisciplinary support is sought.
However, it is important to acknowledge that there are a number of factors that can contribute to difficulty in establishing healthy behaviours, including:
- education, family health or social issues (e.g. deprivation)
- individuals with differing life priorities
- complex child care arrangements
- children/families with intellectual, medical, mental health, physical, or other disabilities
- parent/carer’s lack of knowledge or motivation regarding prevention of dental disease
Therefore, when advising the parent/carer of their key role in improving their child’s oral health, each dental professional needs to be aware of these factors and be empathic, non-judgemental and supportive. The parent/carer’s ability and motivation to take responsibility for their child’s oral health at all stages of providing dental care needs to be considered. If this is in doubt or lacking, engaging in multidisciplinary support may be required to improve this. Supporting people to change their attitudes and health behaviour takes time and patience, but changing behaviour is possible.
In some circumstances, where there is lack of compliance with preventive care and advice, or where the advised and scheduled care is not taken up, dental neglect may be suspected either as a standalone issue or as part of an overall picture of neglect. Dental neglect has been defined as ‘the persistent failure to meet a child’s basic oral health needs, likely to result in the serious impairment of a child’s oral or general health or development’.24 Where suspected, the clinician has a responsibility to the child to pursue this using established child protection procedures.25 Dental professionals should be aware of who to contact when additional support is required. For further guidance on the provision of additional support and identifying and managing suspected dental neglect see Providing additional support.
Ensure that local additional support contacts are available and kept up to date in the practice.
Take a full medical, dental and social history to help understand the ability and motivation of the parent/carer and child to maintain oral health.
Provide appropriate information and support to enable the parent/carer to maintain and improve the child’s ongoing oral health and ensure that they fully understand the information given, using translation services or alternative formats if required.
Encourage compliance by initially tailoring preventive care and treatment to the situation as it is at present, rather than how you would like it to be or think it should be. For example, be prepared to provide care in phases over an extended period, and to negotiate planned treatment.
If you have concerns about compliance or attendance, consider contacting other professionals (e.g. the child’s health visitor, school nurse, general medical practitioner, Childsmile dental health support worker, social worker) for advice and support in the future dental health management of the child.
If after initial assessment or during subsequent management and consultation with others you suspect dental neglect or have any other concerns about the child’s wellbeing, act to provide additional support measures for the child and parent/carer. Give the advice and care outlined above and also follow the advice set out in Providing additional support.
If you have concerns regarding the child’s immediate safety, consider the need for a child protection referral. Follow the advice set out in Providing additional support.