Pediatric Sensory Design Resources - Small Bites X Dr.Toothlittle

Part 2: What Goes On In The Minds of Hypersensitive Kids?

DR. PREMILA NAIDU, MDS — Mon, 12 Aug 2024 17:10:20 +0000

This is Part-2 of a 3-part series on Hypersensitivity/ Oversensitivity impeding access to pediatric dental care.

Hypersensitivity isn’t a sign or symptom. It is a behavioral trait, one which the child or adults don’t realize themselves. Highly sensitive children are deeply attuned to what happens in themselves and the spaces around, and often experience things differently to what many of us feel. Today’s fast-paced world is one of constant bombardment, of constant triggering from mobiles and gadgets, flashes of light from billboards and tech, noise and chaos from traffic and other sources. There is rarely a moment of respite, peace and quiet. Compare this to earlier times, where children were allowed to be by themselves, get bored, find hobbies or keep themselves occupied, and in thus doing were able to find ways to manage stimuli, regulate emotions and course correct whenever they were overwhelmed. With all of this chaos and volatility, it is hardly surprising that children are overwhelmed and react.

As parents and guardians, it is important for us to know what goes on in the minds of children. How they react when they’re overwhelmed differs from one to the other. Hypersensitivity manifests differently in different situations. At the pediatric dental clinic, it may mean children creating too much of a fuss or refusing to co-operate with the dentist for simple instructions like ‘open your mouth’. At the school, it may mean them staying by themselves, or unforeseen outbursts when pushed to deliver on an assignment or homework.

What are the traits of hypersensitive kids and how can we interpret them in a way where it can be addressed?

Hypersensitivity in children plays out in two distinct ways. Mental or emotional hypersensitivity where too much stress or pressure on the brain causes children to react strongly. The child becomes overly aware of the surroundings, either disconnects and zones off or goes deep into thought frequently. Physical hypersensitivity where the child reacts strongly to stimuli of any kind – sounds such as sudden loud noises, sights such as too harsh lights, touch which can be either prickly or hard surfaces, smells or scents that linger in a regular clinic such as the smell of disinfectant which often go unnoticed by the rest of us, and even tastes – the metallic taste of medicines or excessive bitterness of a lemon.

While experiencing the world more intensely than others, these children need to be understood deeply. We need to know more about what drives them and why they behave as they do. As parents it is upto us to decipher their thinking and actions, so as to make it easy for them to understand and react with the world and grow up interacting with it easier than from a state of constant conflict.

One thing to note before listing down hypersensitivity traits of children, is that it is not about unruliness or purposeful or even defiance by itself but a reaction of the child to some kind of stimuli which they can’t control.

Behavioral Indicators
Behavioral indicators are the very obvious signs that children display either to parents or even care providers to notice. Some common ones are,

Dislike towards loud noises, harsh lights, and specific clothing and surface textures
Easily startled by sudden noise, movements, activity
Resists changes in daily routine
Has meltdowns or tantrums, displays unprovoked behavior when becoming overwhelmed by emotions
Requires frequent downtime or break from stimulating situations

Emotional Indicators
Emotions are extreme and all over the place triggered by heightened sensitivity to stimuli and emotions. Small children have no other ways to articulate or express than this, and it can get overwhelming for them and the parents.

Experience emotions intensely and immediately
Picks up on others’ emotions and are highly attuned to others’ feelings
Easily offended or hurt by questions, criticisms and feedback
Thoughtful and introspective, zoning off during pressure situations and require time to process their emotions
Prone to anxiety which cannot be articulated, especially in unpredictable or uncertain situations

Social Indicators
Social indicators of a highly sensitive child often revolve around their interactions with other kids, the parents or immediate family, doctors, dentists or third party people who have to intervene with their health at specific times.

Feels drained in large spaces, groups and prefers immediate familiar people
Observes others, gauges other’s moods before interacting
Takes time to warm up to new people and is selective with their friendships
Strongly dislikes certain activities or social situations and can do anything to avoid them
Appears shy or withdrawn or aloof

Over-sensitive or hypersensitive children need to be dealt with differently than others. They need to be prepared when taken for something big such as a visit to the dentist. It is only when they go of their free will or are comfortable with people, is when the tasks become easy.

It is this reason why Small Bites Dental Clinic recognizing the need to tailor services for its little patients, has built a space that is free flowing, fun and themed, so children of different sensitivities do not get overwhelmed and over-react. By building a Sensory Adaptive Dental Experience Center (SADE), the pediatric dentists are able to help children with oral care without being overwhelming or stressful for them.

For Part 1, read here.

In Part 3 of these series, we try to understand what Small Bites has that makes it apt to address the needs of hypersensitive children and the stressors that otherwise can overwhelm them.

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Part 1: The Big Emotions That Define Hypersensitive Children

DR. PREMILA NAIDU, MDS — Sat, 13 Jul 2024 14:16:11 +0000

This is Part-1 of a 3-part series on Hypersensitivity/ Oversensitivity impeding access to pediatric dental care.

Oral care is fundamental to health and well-being. But so many of us growing up haven’t paid enough attention to it. The occasional tooth pain or gum bleed was always relieved with homemade kitchen remedies or ‘ghar ke nuske’. While these helped in the short term, many issues were carried into adulthood, which showed up as weakened teeth, easy chipping, hidden caries and more as adults. Having learnt our lessons with age and experience, it befalls us to ensure children today don’t have to go through the same cycle of bad oral health. But oral care is much more than getting checkups or bad teeth. What if the reasons for inadequate oral care in children go beyond physical and instead into over-sensitivity to stimuli, avoidance of touch, fear of sharp instruments or even the excessive sound that accompanies the use of dental instruments?

Hypersensitivity is one of the hidden yet recently understood reasons why so many of us have avoided the access to early oral care. It can happen by itself or as a part of a bigger issue to do with growing up, hidden traumas, unaddressed developmental issues or unallayed fears. Many of us when older have realized things that could have been addressed early, but with constant delays have escalated to them becoming unmanageable.

How then does one address hypersensitivity in kids, and what can parents do to manage it better?

A hypersensitive child experiences the world more deeply and intensely than others. A heightened sense towards stimuli like noise, light, emotions and textures makes them react strongly, resulting in them being overstimulated and overwhelmed. Sometimes they react to this by acting up, some other times they shut down and refuse to follow instructions. Often, they get angry or are irritable, getting unreasonable in behavior.

As parents these reactions are often considered as part of the child’s normal psychology or just their way of acting up. But it can go deeper than that. A resistant child or uncooperative child is a child unwilling to follow instructions, instead putting up barriers to everyday tasks like meals, play, studies and even getting regular dental care. Tasks like brushing and gargling become a battle of wills, with perennial fights leaving everyone exhausted.

Highly sensitive children are feisty children. They don’t ‘overreact’ on purpose but have big emotions and don’t know the proper way to express them. Oversensitive children show a few common traits irrespective of what the stimuli is or how is it affecting them;

Experience emotional extremes – They feel the world deeply and react strongly, often not in the way parents expect. Their emotions go from one moment of sadness to another moment of elation, and their senses are stimulated constantly.
Experience sensory over-stimulation – They are highly sensitive to sensory input like smells and sound, texture and light. They may be afraid of bathrooms if the flush is too loud or may not want to walk on very smooth floors.
Prone to meltdowns – When they get triggered with the slightest things pertaining to their sensory overload, they get overwhelmed into meltdowns, showcasing oversized emotions, reacting in the extremes to simple triggers.
Finely tuned to everyone & everything – Oversensitivity can lead to over-processing of information, pre-empting what will happen, preparing for the worst. This is often followed by excessive reaction to simple stimuli.
Excessive need for control of situation – Overwhelmed children don’t do very well with sudden actions or being in unprepared situations, like a visit to a dentist where a simple check might lead to deeper assessment or a series of oral interventions.

Over-sensitive or hypersensitive children need to be dealt with differently than others. They cannot be rushed into a dental clinic, should not go in unprepared and must be worked with to make the whole experience fun and engaging.

In Part 2 of these series, we try to understand what goes on in a child’s mind when dealing with overwhelming or new situations and how can parents help them prepare better.

The post Part 1: The Big Emotions That Define Hypersensitive Children appeared first on Small Bites X Dr.Toothlittle.

9 Steps Towards Handling Children Who Can be Overstimulated at The Dental Clinic

DR. PREMILA NAIDU, MDS — Thu, 16 May 2024 12:41:19 +0000

Dental visits are as non-negotiable as a visit to a pediatrician for children. Unlike adults who can be treated after the incident, in children prevention is better than cure. And to prevent anything major, parents must take their wards to the dentist starting as early as 1 year. Children react and respond to their immediate surroundings, don’t listen to reason, and can be very overwhelmed in the moment, enough to interfere with any procedures done on them. Therefore, finding the problem early, helps in averting it.

Children today are increasingly being looked at as individuals with their own ways of accessing the world. Since everyone of them responds differently to the environment, ensuring their sensory needs are taken care of and not overloaded means understanding their sensitivities for calmer, more relaxed visits to the dentist. Gone are the days when children’s cries and stubbornness were considered as ‘attention seeking’. Today parents are attuned to the needs of children, especially in helping them find ways to go about life and yet address what troubles them. Dentists too are adapting clinics and dental centers to include features such as soothing music, low lighting, projected images moving slowly across the ceiling and multimedia like TV to relax everyone at all times.

Why do children handle dental visits differently than that at a general physician?

Many reasons induce into children a fear of dentists. Perhaps the most plausible explanation is that dental clinics are quiet, sterile spaces with sounds of motor whirring, machines and movement that comprise the constant sounds. It can be daunting for kids given that the general physicians they go to only perform general checkups and don’t need machines to go about their jobs. But there could be several other reasons why a child who is sensorially overwhelmed may dread going to a dentist. This we have observed over a large cross-section of children:

Fear of pain
The look of instruments like drills
Past bad experiences
Fear of the unknown
Stories they have read in books
Stories they have seen in cartoons
Stories they have heard from siblings, classmates, friends

In addition, there could be other attenuating circumstances triggering a child;

Difficulty coping with bright lights
Fear or pain caused by loud sounds
Discomfort in unfamiliar places
Discomfort over textures, such as the chair beneath them
Inability to relax around strangers
Difficulty coping with breaks in routine

Any one of the above can account for a child’s behavior change as soon as he or she walks into a dental clinic. It doesn’t even account for other everyday annoyances we as adults take for granted, which may include traffic sounds, loud noises of cats and dogs, wait before appointments, sounds coming from closed doors, etc. Children often carry all of this stress even before they get into a dentist’s chair and it all explodes or aggravates when seated on it.

What are the 9 steps that parents can do, to handle their overstimulated children even before they get to the dentist?

Make a casual visit to the dentist first, find one who has a dental clinic that is child friendly, sensory adapted and whose references vouch for the treatment. Such a dentist must understand that the needs of every child is different, and adapts their conversation and treatment to suit the little patients. Find a dentist ahead of time, research about them and especially one you can continually go to for various different ailments.
Begin explaining the process of the dental visit to your child many days ahead of the appointment, if possible. Show them videos, books, or drawings that go through everything step by step. Research about the dentist, help your child connect with whom they are going to meet and what to expect.
Mimic a fake dental visit where you play the dentist, so they can get a feel for the procedures and exams.
Make sure you are with them and follow their routine through the day in every way other than the visit, to lessen their anxiety.
Remain communicative and present at the dentist before, during and after the dental examination, never losing sight of them.
Lessen sensory triggers if any as much as possible; bring sunglasses or a sleep mask for lights, earplugs or headphones with soothing music for sound, and a special toy, blanket or other comfort object.
Talk to the dentist freely before the procedure and explain about your child. They will not know what to expect as signs of your child’s distress, but you do. You can let them know when breaks are needed, or if there is something they can do to make the process go more smoothly.
Consider sedation or Nitrous Oxide (Laughing Gas) which dental clinics like Small Bites are equipped with in case the child needs more relaxing for an especially difficult procedure. Though a last resort, for long, painful or frightening procedures, you may wish to consent to your child being put under for the duration. Please bear in mind that this has to be planned in advance, so have a word with your child’s dentist before finalizing an appointment. You may also wish to speak to your child’s primary care doctor or pediatrician when this is done.
Begin good habits as soon as possible. One of the most important things you can do for your child is to make sure they take good care of their teeth however old they may be. It is never too late to start the prevention process with good brushing and oral hygiene. This won’t mitigate the need for annual exams, but it will lessen the chances of serious dental procedures later on. The best treatment is often prevention, especially when your child has difficulty managing appointments.

The concept of a Sensory Adaptive Dental Experience Center (SADE) is one that we at Small Bites have been championing since the last 17 years. Everything that we do, from the way our 2 clinics in Indiranagar and Bhartiya City have been designed, to the interiors that are adaptive to the little patients and even our different approaches to the same condition based on the needs of the child, have been conceptualized as relaxing them and providing an atmosphere that helps, rather than instills fear in little minds.

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Part 3: How Sensory Adaptive Dental Experience Centers (SADE) Help Facilitate Respect for Child’s Boundaries

Dr.Charmaine Kenita — Fri, 23 Feb 2024 15:05:29 +0000

This blog is a part of a series on ‘Sensory Design for Pediatric Dental Clinics in India’. You can find Part 1 here & Part 2 here.

Small Bites Sensory Adaptive Dental Experience Center

Sensory design in medicine is a relatively recent concept, although Small Bites Dental Clinic is one of the first to have pioneered it for children in India. Dental clinics and even hospitals in general have always been designed in keeping with the services offered. Come to think of it, the sterile environments and stark spaces found in hospitals came about from the need to calm patients, ensure there were no distractions; a sober, quiet place for people to wait their turn for appointments and doctor visits, procedures and other medical interventions. The need was therefore led by the medical practice and to provide environs that sustained such practice. Patients were viewed as individuals who had to adhere to the protocols of the space to receive necessary treatment.

At the turn of the century, things slowly began to change. It was noticed that patients who visited clinics and especially children, were oftentimes agitated during the wait for doctors. Anxiety increased and clinics began to be considered foreboding and uninviting. This feeling was especially enhanced for those with sensitive temperaments and those who had an inherent fear of doctors. It was observed and even researched that the place, its decor, design and surroundings played a big role in children’s comfort levels. Thus began the need to change the design of dental centers, understand the people who came to them, adapt the environs to their needs and make it a patient-led endeavor.

Sensory adaptiveness of children in the case of Small Bites Dental Experience Centre has shown a significant impact on little lives, through our years of practice. What began with experimenting and ensuring children were met with big smiles, colorful walls, coloring books, multimedia and toys, has gone on to include so much more. Today our clinic is designed with material that is sensorially adaptable to different types of people. From textured flooring, to transitioned lighting that can be dimmed and brightened based on the needs of little patients, versatility in media including sounds and visuals, to different kinds of toys; we have observed how children and adults alike relax and calm down immediately in our spaces. Our observations over 15 years have led us to believe and now further the mission in educating about safe spaces for children. Below are few of the things we’ve seen during our practice;

Calming the dysregulation – Every individual perceives the world according to their senses, and everyone’s threshold is very different. Children who are still adapting to the surroundings with age are especially vulnerable, more so when there is the added fear of doctors and machines and strange people doing things to them. Sensory Adaptive Dental Environments (SADE) help in making them adjust to the change in environments, and by doing so calm down the dysregulation they experience.
Introducing predictability – Children love routines. The predictability of such routines means that they know what’s coming or are prepared to experience it before it even happens. Sensory experience centers introduce a predictability to their dental interventions. By visiting spaces that calm them down, they begin to look forward to the experience despite the medical intervention, rather than fearing it or avoiding the experience altogether.
Regulating reactionary behaviors – Children can stress and often the way they exhibit the same is very different from adults. From crying and screaming before the checkup even begins, to aggression and hitting back out of anxiety, aimless uncontrolled running to constant fidgeting of limbs; anxiety, fear and discomfort shows up in many unpredictable behaviors. A space that is familiar to home, with all the materials that distract them, help children adjust faster which is very essential for complex medical procedures or even if general dental checkups have to be done. This is what a SADE center provides.

Dental care has to be child-led and one we have been practicing since several years. Our experience has taught us how every child is unique, accommodative and a good receptor of information provided they are listened to, their needs met, and their boundaries respected. At Small Bites, our dentists and medical staff ensure that pediatric dental care goes beyond treatment to making every child feel heard and seen.

The post Part 3: How Sensory Adaptive Dental Experience Centers (SADE) Help Facilitate Respect for Child’s Boundaries appeared first on Small Bites X Dr.Toothlittle.

Part 2: The 3 Criteria for Sensory Space Design in Pediatric Dental Clinics

Dr.Charmaine Kenita — Wed, 27 Dec 2023 09:37:13 +0000

This blog is a part of a series on ‘Sensory Design for Pediatric Dental Clinics in India’. You can find Part 1 here.

As people, we perceive what is around us through our senses. Therefore, none of our realities are alike. Even people from the same family or with similar genetic traits feel their surroundings differently. At the basic level, sensory perception is the use of senses in our possession – hear, sight, taste, touch, smell to constantly and continuously assess the world around us. In earlier times, our ancestors relied on only these to keep themselves safe, to hunt for food, to smell danger and more. As people began to settle, develop communities, and build structures, our reliance on senses considerably reduced with the increased comfort and predictability around us. However, as humans, our inherent nature still depends on an assessment of the surroundings, and we must recognize more than ever the need to respect, address and ensure that whatever the kind of surroundings people are in, it must make them relaxed and must be tailored for the amount and kinds of stimuli they can take. This is where sensory space design in dental clinics comes into play.

In dental care and general healthcare centers, the need for sensory adaptiveness is greatly required, because people often visit the space in a compromised state. A child visiting a clinic is already vulnerable to excessive stimuli, afraid of the newness of the place, unsure about what to expect, and with undeveloped emotions to deal with the situations presented to them. In such a scenario, the only way to make them comfortable for any kind of treatment is to ensure that the space adapts to their individual needs. This is a tall ask for a clinic that caters to many different children with different needs. Below therefore are 3 common factors or criteria that can give you insights on common sensory space design concepts for pediatric dental care.

Space as a trigger for stimuli – A dental center goes beyond just white walls and minimal, strict seating. Because of its starkness and predictability, it can be intimidating for children, and often even adults. Those with sensory issues or heightened response to stimuli are even more overwhelmed with healthcare centers or dental clinics. It is therefore important to bear in mind that a space that calms little ones must be open, wide, airy and bright. It should flow like water, from the sitting area to the corridors, from the rooms to the spaces outside. Filled with all kinds of things that children love, it is almost like replicating their play rooms, ensuring that they forget where they have come and what is it they need treatment for.
Resonant with child-led themes – Equally distracting for children, and at once giving them a feeling of stepping into a wonderland is the theme with which the clinic has been designed. Whether a sports themed space with painted walls and games to indulge in, or balloons all over and a feel of clouds, children lose themselves in the wonder of the place. At Small Bites, the beach-themed interiors envelop the entire space, from the textured wave-like flooring to the wooden oars, boatyard themed wall décor and sea themed subtle lighting, ensuring the child doesn’t even realize the work that’s happening with their teeth and is so lost in the space.
Adheres to sensory perceptions – Sound can be very triggering for children, the continuous single-tone decibels or even contrasting silence can be very unnerving for them. To counter the surrounding silence or alternate loud noises, clinics should be designed with acoustic absorption, textured flooring and carpeting to absorb excessive sounds. A varied soundscape gives children and even adults calm acoustics to center them, calm them and navigate the time spent.

Similar with sight, is the need for space to have soft lighting, natural light as much as possible. At Small Bites again, each of the dentist’s rooms are embellished with multi-layered, multi-colored lighting that can be dimmed and brightened based on the need of the doctor or the patient’s comfort. These are intriguing, playful and transform the space from floor to ceiling like a deep-sea exploration experience.

Touch is an equally crucial aspect to Sensory Adaptive Experience Centers (SADE). Texture plays a very important role in comfort; from the textures of walls and floors that the child walks on, to the upholstery and carpeting. Having varied textures makes the ambience more versatile and comfortable for children to adapt to.

In the design of SADE pediatric clinics, it is essential to consider a child as a patient, but also the individual whose sensory needs must be met with, in addition to the physical and medical needs. Small Bites has ensured that every aspect has been tailored specifically for this, making it one of India’s only Sensory Adaptive Experience Center, and extensively championed by Dr.Premila Naidu, who works with kids of all ages and all kinds of sensory needs to make the dental experience most comfortable for them.

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Part 1: The Origin of Sensory Design in Pediatric Dental Clinics

Dr.Charmaine Kenita — Sat, 14 Oct 2023 04:53:41 +0000

The world around us is defined by our senses. What we perceive with touching, seeing, feeling, hearing and tasting affects how much we like being in an environment or getting away from it. Sensory perception thus is very valuable, helping us assess what’s outside of us. It is a primary skill, inborn and learnt as babies which grows in depth and intensity as adults. The acuteness of it as children does tend to reduce with adult distractions; but like ‘gut feeling’, helps and guides a majority of our decisions.

Sensory experience is an ignored overlooked aspect of the way the world is designed around us. Design decisions in our surroundings, the way outside influences stimulate us is often never considered important enough. While public and private spaces take care of sensory perception in a general way – dim lighting in hospitals is an example, the interplay of sensory perception and space design in medical practice is not a standard part of best practice guidelines.

People are unique, and therefore their sensory perception even more so. Some are overstimulated by noise, while some others face debilitated functioning when confronted by too less of it and need it in some form always. Some like texture in touch, which calms them while others love the feel of smooth finishes to enhance their moods. This can help or hinder people’s full participation in society, since they are constantly trying to avoid their triggers and find other avenues to work around it. The design of spaces can do well with being more inclusive by taking a sensory approach. People who have to live with heightened, reduced, or complete loss of senses can then be free to work and function, thus enabling support for diverse sensory and other heightened problems.

Hospital and clinic environments especially need such sensory approach to design, given that people already walk in with a range of illnesses, impairments and emotions. At Small Bites Dental Clinic, sensory perception and inclusiveness defines our spaces and the way we approach treatment for everyone.

As one of India’s leading children’s dental clinics complete with pediatric specific methodologies, themed interiors with toys and learning materials, multimedia and technology that makes dental interventions stress-free and pleasant, and experienced pediatric dentists, Small Bites is one of the country’s leading dental experience centers to incorporate sensory design into its physical architecture. While Dr.Premila of Small Bites has been at the forefront in spearheading new innovations in treatment, including the latest ‘laughing gas’ intervention to relax children during complicated procedures, the clinic space has also been adapted to make it more open, comfotable, warm and welcoming for everyone. Created in a ‘beach theme’ complete with pebble and sand like granular textural walkways, to varied mood lighting, and soundscapes, the clinic incorporates a design that facilitates exploration, engagement and experimentation.

At Small Bites, sensory design was a key feature when the clinic was created, with a particular emphasis on making the waiting and treatment rooms engaging, warm and friendly for all children. From tactile walls and flooring to adjustable light brightness for different moods and functional interaction, everything was thought through to give the children the kind of ambience that immediately made them lighter, brighter and more open.

Sensory design also called ‘Biophilic design’ is a good healthcare practice tracing its roots to the principles of Florence Nightingale. Her concepts speak about spaces impacting treatment outcomes, how they must differ for different sets of people, and what works the best for everyone.

Dental clinics cater to some of the most stressful moments in a child’s life, and we know how a better environment can foster better dental outcomes; a more accommodating child, a child open to instructions and asks, and who then considers the space safe and the dentists’ friends they would like to meet again and again.

Like Dr.Premila shares about her idea in designing the clinic, ” A space where children can be free, outgoing, inclusive and where dental care doesn’t become a stressful experience for everyone is what I wanted to create.”

Keep reading our series on ‘Sensory Design in Dental Clinics’ and explore what has gone into our dental space and how we have gone about it.

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