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Do You Allow Your Children to Make Medical Decisions?

So this is your child's x-ray. Now what?

 

I had a 14 year old boy come in for an initial consultation.  At his regular dental appointment, his general dentist took an x-ray and noticed that his upper permanent canines seemed to be stuck and recommended he see an orthodontist.  He was very upset about the notion of having braces placed right before he was going to start high school.  In an attempt to calm her son down, his mother assured him that he would be involved in the decision on whether or not to proceed.  She also mentioned that the orthodontist would only need to place a couple brackets and that it would probably only be a few months.  I was not informed of any of these conversations prior to the exam.

After looking at his occlusion and the x-ray, I presented my treatment plan.  Full upper and lower braces, surgical exposure of the upper right canine (for you non-dentists this is the one on the upper left on the x-ray) and the extraction of the upper left primary canine would probably encourage the left permanent canine to come in on its own.  The estimated treatment time was 24 months.  Needless to say, mom and child freaked out.  I was then informed of their previous conversations and of the fact that this child was going to make the decision on treatment.

The boy immediately stated that he did not want braces and he wasn’t going to do anything.  I discussed the risks of leaving the upper right canine impacted in his upper jaw:

1.   Potential damage or loss to adjacent teeth

2.  Risk of dentigerous cyst formation which could cause damage to teeth and jaws

3.  Continued eruption of the tooth that could emerge in the palate at any given time

4.  Future ankylosis (fusion of the tooth to the bone)

I also told him that the baby tooth that was in his mouth may not last forever and that if it is lost, he will end up with a space towards the front of his mouth.  Mom was convinced that he should have treatment, but was torn because she promised him he would get to decide.  They went home and eventually contacted the office to let us know that he did not want braces or surgery, so they are going to leave the tooth and do nothing.

I can understand allowing a child some say in their healthcare.  It is their body, after all.  The thing that bothers me about this concept is that the child’s brain is not developed enough to process all the information and to consider the long term consequences of their decisions.  Yes, braces in high school sucks.  And, the surgery is going to hurt.  Would it suck more to lose that baby tooth right before your wedding, or to have that impacted tooth destroy your front teeth?  I have had countless consultations with adults wishing their parents had forced them to get braces as a child.  So I leave this with the moms out there.  What would you do if this was your child?

9 Responses to “Do You Allow Your Children to Make Medical Decisions?”

  1. If is so hard to believe that a child will make such an important decision. When we as parents lost the right to be parents? when did we lose the right to tell our child: “I am the parent not you and therefore I will make that decision.” I feel so old school here but a child should know his/her place in the family rank, and the parent should have the strenght to stand his/her ground. My Alex was not happy with the expander as you know, but it did not matter how he felt, it mattered how good the quality of his bite and upper palate expansion was going to effect him and prevent invasive, expensive and painful surgery a 1-2-3 years down the road.
    Thank you Courtney for sharing this, maybe more parents will become aware that they are and should be in control.

    • Courtneyadunn says:

      Agreed. It would have been most appropriate for the mom to say, “I didn’t know how serious this was when I told you that you could decide. I’m sorry, but you have to do this. I know you are unhappy, but this is the best decision for your long term health”.

  2. Carlene says:

    I enjoyed reading this. Thanks

  3. Sal Lanfranco says:

    Wonderful blog!

  4. As a child, my parents had the final say. As a show of respect and faith, we did not question them. Parents need to realize that children are just that (children)!!!!!!

    • Courtneyadunn says:

      Bonnie,
      I completely agree. Aren’t you finding that a lot of our patients don’t have as much respect for their parents? Does that make us sound old? – LOL

  5. Lisa says:

    It is good to provide choices for our kids as it gives them a sense control over their enviroment.. But as i have learned over the years how to provide choices that are acceptable to us in the end.. In the end thiugh the parent has to make those tough decisions, because they are the adult and as an adult you understand the ramifications of a decision that a child may not have developed the insight for yet.. Like we always tell our kids ” at the end of the day i am the parent and you are the kid”=

  6. Blythe O'Donnell says:

    No, I think that sums up my thoughts.

  7. Calum says:

    I wouldn’t listen to Giangi or bonciel
    they’re discussing the issue, but in a “I just want something to rant about about” kind of way.

    I believe that children should have a say in medical decisions regarding them, but yeah in this case if I were the mother I would probably (with explanation and apology) put my foot down. She REALLY shouldn’t have made promises she didn’t know if she could keep; she set herself up to lose either way, her child’s trust or her child’s health.

    I’m glad you considered the issue rather than just rant about it 🙂 Giving choice was likely wrong in this case, but that doesn’t make it wrong in all cases.

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