Up High in the Trees (and at the dentist)
July 18, 2007 by Kristina Chew, PhD
Filed under Health
I am borrowing that title—-Up High in the Trees is the title of a just-published novel by Kiara Brinkman. The main character is 8-year-old Sebby who, after the death of his pregnant mother, goes with his father to the family summerhouse; described as being on the autism spectrum, Sebby writes letters to his favorite teacher back home. Kiara Brinkman is reading tonight, Wednesday, July 18th, at the Barnes & Noble (Astor Place) in New York City at 7:00pm (check out her website with its delicate line drawings of a tree and a boy).
I have yet to read Up High in the Trees—it will be one of the books to pack when we go to the beach in August—-but the title was echoing in my head this morning, that image of being up high.
Charlie likes to be up high—-something about being “above it all” and able to look down and see things from a panoramic perspective: Perhaps, it occurs to me, this is why he used to stand on the edge of the diving board for minutes and minutes and minutes and smile and look around, and bounce a bit on the board. When he was about 5-8 years old, he seemed to have put himself in training to be a rockclimber, as he scaled the piano, the chests of drawers, the windowsills. He has never shown any fear about getting up on a balance beam and walking. But when I was thinking of Charlie being “up high” this morning, it was for something a bit more prosaic: We were at the dentist and as Charlie seemed more comfortable kneeling on his feet, the dentist obliged him by putting the dental chair at its highest setting, so Charlie indeed seemed “up high” (and he looked around himself with a bit of renewed curiosity).
Charlie had his best-ever visit to the dentist: Teeth counted, plague scraped off, teeth brushed and flossed, and fluoride applied. As his appointment was at 8am and we were out by 8.30am, I felt very much as if a full, and a good, day’s work had been done.
A few things contributed to a successful visit: First, the dentist’s flexibility and willingness to accommodate for Charlie’s needs, from moving the chair up to not using the mechanical tooth brush to polish Charlie’s teeth or the bubble-gum flavored tooth paste (I had brought Charlie’s own mechanical toothbrush and he was okay using this instead). Second, for the past year, Charlie’s ABA therapists have been practicing “being at the dentist” with him: After watching him struggle against the hygienist holding his hands while Jim and I tried to keep him still in the chair, we concluded that we must teach Charlie to lie still with his mouth open and his hands down, for brief periods of time. We have been having Charlie lie down on his bed and open his mouth—the starting time was one second, and this went up to five seconds, then ten, then twenty, then thirty, to a whole minutes. We also practiced using a floss stick and putting a dental mirror (purchased at the drug store) in Charlie’s mouth, and placing a rubbery mask over his nose—-the mask being used to administer nitrous oxide (we tried that this morning, but it just made Charlie more giggly). And we made the whole process a matter of cheering, encouragement, and (as much as holding one’s mouth open for periods of time can be) fun. Third, we agreed that no force must be used—nothing at all suggesting a restraint. Fourth, Charlie’s home ABA consultant (who used to be one of his therapists) came to the appointment and, when it came time to count his teeth and the dentist (who was very compassionate and determined, but rather anxious) was starting to tense, Charlie’s therapist stepped forward, held his hands gently and (with an easy smile and radiating confidence in him), said,
“Count like we do at home—1, 2, 3, 4, 5,…..”
Charlie looked her in the eye, smiled and (with the dentist quickly getting to work) kept counting. “Wow,” said the hygienist.
Much as I hope that Jim and I can take Charlie on our own to the dentist and do as well, the more I thought over “what worked,” the more I realized that the presence of his therapist was necessary and not only because she was able to keep her emotions more in check than us. I think when Charlie saw her, he got into “learning mode”; he was more ready, he was presdisposed, to follow instructions.
No cavities, too.
When Charlie came down from the dental chair, he was not the only one flying high.
Photo courtesy of MBK via Flickr
It was nice to hear of Charlie’s postive experience at the dentist…especially since we just had a really negative one this week (we’re hoping it was a blip though because he normally does well). Patrick hates the taste of the polish toothpaste…what do you use instead?
Kristina,
Thank you for the information regarding the dentist visit. My son, who has autism, is 6 years old needs quite a bit of dental work. We found out he had an absessed tooth on our first visit to this dentist. I researched, visited, planned and worried before his inital visit to find the best, most flexible place for him and believed I had that. The cleaning went well, but when we went back for the extraction of the absessed tooth, the gas sedation that they used wasn’t given enough time to work so they had to restrain him and force him to open his mouth. Needless to say, it was very traumatic. I was extremely disappointed in their handling of this considering I had done so much prep work educating myself on them and educating them on my son. After that, I spoke to the office regarding a different form of sedation for the next visit that he had scheduled for more work on his teeth, though less invasive than the first one. They were unwilling to offer other possibilites for making him more comfortable. We have since paid our bill in full and plan to find another dentist.
Thank you for the 4 “guidelines” that you posted. We’ll try those and hopefully get better results next time.
high quality medical care is a very new thing for ‘disabled’ people. Not long ago we just did not get dental care because doctors actually just said it did not matter what our teeth looked like. Because of this many doctors simply do not know how to treat us. As a young adult I was under the care of an expert neurologist for some issues. At that docs request I went to the local teaching hospital to let the ‘baby’ neurologists and psych people examine me for their training. It was interesting the ideas they had-and got in trouble for by my acting physician. I was probably the first of my kind they had seen in real life.
My parents were determined that I get good dental care and would have even gotten me braces or caps if needed. Due to early dental care I have lovely teeth now.
Good on you Moms that are willing to seek equal or better care for your Autistics kids.
~Sarah
mumkeepingsane, The dentist just mixed some powdery stuff with water—I think it is the stuff that makes the polish toothpaste gritty (???). He told us to bring the toothpaste Charlie likes (a certain kind of Crest blue gel with baking powder) and that he would mix in the powder. This was our first positive experience in years, if not ever! Hope Patrick is well—
Dear Tonya, Sounds like your guy was, is a real trooper—Charlie has not had any serious teeth issues so far (knock on wood). A friend’s son had an abcessed tooth and they put him under —- at this point, restraining Charlie always brings bad consequences (understandably). Hope you found a much better dentist—this took us a lot of trial and error too!
Oh, the trepidation I feel about taking Nik to the dentist! His first visit was not good…the whole restraint issue. I found out recently that the dentist has since retired and there is a wonderful new guy in his place. We’ll find out the truth of that statement next week…I’ve been working with Nik on toothbrushing. He will let me brush his teeth if I sing a special song. When he closes his mouht on the brush, I stop singing. If he wants the rest of the song, he has to “Open Wide!” LOL Good thing he’s so motivated by music! Not sure how to deal with the restraint issue as Nik will NOT sit still for more than a few seconds at a time and not at all if he is leaned back. Hmmm…will start working on that this week at home.
Congratulations to all of you! Charlie, Mom, Dad and therapist. I would love to learn more from you about how you “bend” with Charlie’s body and avoiding the restraints. This year John had to be placed under full anesthesia in order to have several cavities filled. I anticpate him needed more dental work inthe future. The ABA procedure you described makes a lot of sense. May I ask?… Is the ABA Charlie receives provided through the school district or is this an out-of-pocket expense for you?