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LECTURE
LECTURE

The Rumbling Child — Recognition, Reasonable Adjustments & the Road to Calm

Dr Blessy John-Denny
Paediatric Emergency Physician and Paediatrician, The Children’s Hospital at Westmead, Sydney Children’s Hospital Network

Dental anxiety and behavioural distress are among the most common barriers to oral healthcare in children. For children with autism, the dental environment can become a perfect storm of sensory overload, communication barriers, and escalating stress. Yet every child who reaches crisis point in the dental chair shows warning signs first, we simply do not always know to read them.

This talk approaches one of dentistry’s most challenging encounters — the anxious, distressed, or autistic child — from a Paediatric Emergency Physician’s perspective. Emergency departments often see the downstream consequences: last-resort sedation requests, missed dental pain in non-verbal children, and preventable pathways to general anaesthesia.

Drawing on frontline clinical experience, we explore the variability of autism spectrum presentations. We begin with the rumbling-rage-recovery stress cycle — preparing for and learning to recognise escalation early, when intervention is still possible. We cover what reasonable adjustments may look like in the chair and some targeted questions to a carer that could reframe the encounter as a shared, patient-centred experience. From there we move to the road to calm: play therapy, social stories, and sensory tools and a review of pharmacological supports including its limitations.

Practical tools for clinicians who plan early, recognise nuance, and intervene at the right moment.

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