Faculty of Dentistry, McGill University, Montreal, QC, Canada.
Ingram School of Nursing, McGill University, Montreal, QC, Canada.
Int J Paediatr Dent. 2018 Mar;28(2):189-197. doi: 10.1111/ipd.12325. Epub 2017 Aug 25.
In recent years, conceptions of childhood have been evolving towards an increased recognition of children as active agents, capable of participating in the determination of their wellbeing. In pediatric dentistry, the extent to which these conceptions are being discursively endorsed is not well known.
The aim of this investigation was to examine the discursive construction of childhood in seminal North American pedagogical dentistry materials.
We conducted a qualitative discourse analysis of a sample of prominent texts using a sociological discourse analysis approach.
We analyzed the latest edition of Macdonald and Avery's textbook (Chapter: Non pharmacologic management of children's behaviors) and the clinical practice guidelines published by the American Academy of Pediatric Dentistry, AAPD (Behavior guidance for the pediatric dental patient). The analysis produced five salient discursive categories: socialization through behavior modification; development and behavior; paternalism; the utility of child-centered communication; and consequentialism. While there were instances of a child-centered focus in the texts, the main discourses were rooted in developmentalism and behaviorism. There was scant acknowledgment of the importance of children's agency or voice, which runs contrary to child-centered discourses and practices in related disciplines (e.g., pediatric medicine, nursing).
Predominant discourses in pediatric dentistry suggest a paternalistic, behaviorist approach to the 'management' of children in the dental office, focused primarily on completing interventions. Priorities for the future development of pediatric dentistry are discussed, integrating more child-centered approaches.
近年来，人们对儿童的观念逐渐发生转变，越来越认识到儿童是积极的主体，能够参与到自身福祉的决定中来。在儿童牙科领域，这些观念在多大程度上得到了认可还不得而知。
本研究旨在考察北美主要儿牙教学材料中儿童观的话语构建。
我们采用社会学话语分析方法，对一组具有代表性的文本进行了定性话语分析。
我们分析了 MacDonald 和 Avery 教科书的最新版本（第 10 章：儿童行为的非药物管理）和美国儿科学会（AAPD）发布的临床实践指南（儿科牙科患者的行为指导）。分析产生了五个突出的话语类别：通过行为矫正进行社会化；发展与行为；家长主义；以儿童为中心的沟通的效用；以及后果主义。尽管这些文本中存在以儿童为中心的焦点，但主要的话语还是根植于发展主义和行为主义。这些文本几乎没有承认儿童能动性或声音的重要性，这与相关学科（如儿科医学、护理）中的以儿童为中心的话语和实践背道而驰。
儿童牙科领域的主流话语表明，在牙科诊室中对儿童的“管理”采取一种家长主义、行为主义的方法，主要侧重于完成干预措施。本文讨论了未来儿牙发展的重点，整合了更多以儿童为中心的方法。
