Positive Reinforcement Knee-to-Knee Technique

Positive reinforcement is an effective technique to reward desired behaviors and thus increase the likelihood that those behaviors will recur. Social reinforcers include positive voice modulation, facial expression, verbal praise, and appropriate physical demonstrations of approval. Some other reinforcers include stickers, tokens, and toys. It is important to make sure that the child perceives the nonsocial reinforcers as meaningful.

Knee-to-Knee Technique

The knee-to-knee technique works for most young children. The oral health professional and the parent face each other while seated, with knees touching or slightly interlocking. The child first straddles the parent's lap while facing the parent. The child is then slowly lowered until he or she is horizontal and looking up, with his or her head on the oral health professional's lap. The parent uses his or her upper arms to gently hold the child's legs and feet and his or her hands to gently hold the child's hands. This allows the oral health professional the freedom to use both hands or to use one hand to gently hold the child's head.

The knee-to-knee technique can be used for non-invasive procedures such as examination and fluoride application, as well as for restorative care such as atraumatic restorative technique (ATR). (For more information about ATR, see module 3, section 3.3.)

The knee-to-knee technique can be used in any setting and does not require a dental chair. If the child cries, you have an excellent view of the teeth and oral cavity. While the child is in this position, you can provide the parent with information on how to prevent oral disease and can show the parent normal structures or problems in the child's oral cavity.

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