For some children, the dental chair is the easy part. For others - kids with significant anxiety, sensory sensitivities, autism, ADHD, or any condition that makes typical dental visits difficult - the experience requires more thought, more patience, and more skill from the team. At Nickel Pediatric Dentistry, Dr. Andrew Nickel’s training was built for these visits. This page covers how we approach behavior management (the AAPD’s preferred term is *behavior guidance*), the techniques we use, and what families with anxious or special-needs children can expect.
How We Help Make Dental Visits Easier
Behavior management is the set of techniques pediatric dentists use to help children feel safe and cooperate during dental care without sedation, restraint, or pressure as the first response. The AAPD has formal published guidelines on these techniques - the foundation that every board-certified pediatric dentist is trained in.
The core techniques we use:
Tell-Show-Do
The cornerstone of pediatric behavior guidance. We tell your child what we’re going to do in age-appropriate language. We show them - using a finger, a stuffed animal, or a tool against their hand - what it will look and feel like. Then, and only then, we do the procedure on their teeth.
The transition from apprehension to acceptance is genuinely rewarding to watch. Most kids - including most anxious kids - relax noticeably once they’ve seen what’s coming. This is the AAPD’s foundational pediatric behavior guidance technique, established for decades and supported by clinical research.
Ask-Tell-Ask
For older children, we may use a variation: we ask the child what they expect or are worried about, tell them what we’ll actually do, then ask if they have questions. Recent research (a 2024 PMC study) has shown effectiveness comparable to Tell-Show-Do - and it gives older kids a sense of control.
Voice Control and Nonverbal Communication
Calm voice. Steady eye contact. Open posture. The way we move and speak in the room directly affects how a child feels. We move slowly when we need to. We sit at your child’s eye level. We never raise voices or use clipped, clinical tones with kids.
Positive Reinforcement
Specific praise - “you held still really well during that count” - works far better than generic (“good job!”). Stickers, high-fives, and a small prize from the treasure chest at the end of every visit close the loop on a positive experience.
Distraction
A TV on the ceiling, a song, conversation about a favorite topic - distraction during procedures genuinely helps. We use it when it fits the child.
Caring for Children With Special Healthcare Needs
A significant portion of Dr. Nickel’s training was focused specifically on children with medically complex conditions and special healthcare needs. His pediatric residency at the University of Southern California included rotations across three major children’s hospitals (Long Beach Miller Children’s, Children’s Hospital of Los Angeles, and Children’s Hospital of Orange County), where treating children with autism spectrum disorder, ADHD, Down syndrome, cerebral palsy, neurologic delays, and medically complex conditions was part of the daily clinical environment.
What that means practically for your family:
- A team experienced with sensory-sensitive, anxious, and special-needs children - not figuring it out for the first time
- Adjusted approaches for children whose typical visit doesn’t fit the typical mold
- Coordination with your child’s medical team - pediatricians, specialists, therapists, and educators who are part of your child’s broader care
- Sedation options when needed, never as a first resort
Happy Visits - Desensitization Before Treatment
For children with significant anxiety, sensory sensitivities, or prior negative dental experiences, we offer happy visits - short, low-pressure appointments where your child comes in to:
- Meet our team
- Sit in the dental chair (no procedure)
- Try on the bib and sunglasses
- See the tools
- Listen to the suction sound
- Leave with a sticker
A happy visit might be 10 minutes. We may schedule them once or twice a month over several months before any actual treatment. The goal is familiarity before procedure - desensitizing the unknown so a real visit feels manageable.
This is one of the most underused tools in pediatric dentistry. For the right child, it changes the dental experience entirely.
Working With Parents - You Are Part of the Team
The most effective behavior management isn’t just between dentist and child. You’re part of it. A few things that consistently help:
- Tell us about your child before the visit. A diagnosis, a sensitivity, a trigger, a comfort object - anything you’d tell a new caregiver, tell us. There’s no detail too small.
- Stay calm yourself. Children pick up on parent anxiety more than parent words. A calm parent helps a calm visit.
- Use positive language at home before appointments. “The dentist will count your teeth,” not “it won’t hurt.” Specific examples are on our first visit page.
- Stay in the room if your child wants you there. For kids under 5 especially, parent presence often reduces anxiety significantly.
- Bring comfort items. A favorite stuffed animal, a small blanket, headphones with music, a fidget toy - bring whatever helps.
Your child is the patient, but you’re the partner.
When Behavior Guidance Isn’t Enough
Most children - even most anxious children - do beautifully with the techniques above. Some children need more support, and that’s where sedation comes in. We never lead with sedation; it’s not a first response. But for children with significant anxiety, special healthcare needs, very young children needing extensive treatment, or cases where awake care isn’t realistic, we offer a full range of pediatric sedation options - from nitrous oxide to deeper sedation pathways.
The decision is always made together with you, after we’ve tried the gentler approaches first.
Frequently Asked Questions
What is Tell-Show-Do?
The AAPD’s foundational behavior guidance technique. We tell your child what we’ll do in age-appropriate language, show them on a finger or stuffed animal, then do the procedure. Most kids relax visibly once they’ve seen what’s coming.
How do you treat autistic children at the dentist?
With patience, structure, and respect for sensory needs. We adjust pacing, sound levels, and approach based on the child. Pre-visit communication with parents is essential - knowing your child’s specific triggers and comforts before they arrive lets us prepare. We may use happy visits (short familiarization appointments) before any treatment.
What is a happy visit?
A short, low-pressure appointment for anxious or special-needs children - sometimes 10 minutes - where your child meets the team, sees the chair, and leaves with a sticker. No treatment. The goal is familiarity, scheduled over weeks or months before a full visit.
Can I stay in the room with my child?
Yes. For young or anxious children, we encourage it. For older kids who are comfortable on their own, that works too - we follow your child’s lead.
Does my anxious child need sedation?
Probably not as a first answer. Most anxious children respond well to behavior guidance techniques and time. For children where these aren’t enough, sedation is a real option - we discuss it carefully with you before any sedated appointment. See our sedation dentistry page for the full range.
What if my child refuses treatment during a visit?
We stop. Forced treatment damages the long-term dental relationship and rarely produces good outcomes. We’ll regroup, talk through what’s needed, and reschedule with a different approach (more time, parent in the room, sedation discussion if appropriate). ## Schedule a Visit If your child is anxious, has sensory sensitivities, has special healthcare needs, or has had a difficult dental experience before, please tell us when you call. We’ll plan accordingly. Call (772) 494-6010 or request an appointment online. —
