It’s a pity HOM (Hand-Over-Mouth) is no longer an option to avoid general anesthesia for young children. I was taught to use “the towel method” at Columbia dental school in the mid-'40s, but always felt that was wrong since wrapping a towel over the nose and mouth had the intimation of suffocation; whereas hand-over-mouth was equally effective but not as threatening. Applied properly at the right age, which is probably in the range of 3-6, it can convert a hysterical child into a compliant patient.

For those of you unfamiliar with the technique, the point is to get the screaming kid’s attention. The technique is simple. First have the parent wait beyond the child’s sight, preferably in the waiting room, after having explained what you are going to do and obtaining written consent on a form describing the procedure. Using firm pressure, place your hand over the screaming mouth to muffle the sound, all the while telling the kid in a voice of no uncertain emphasis that you won’t remove your hand until he or she stops screaming. A little thumping on the shoulder with your other hand reinforces the point. As soon as the kid quiets down, remove your hand. And then, in a quiet, reassuring voice, apologize for having to do what you just did so that you can explain what’s going on. [Repeat as necessary if the kid begins to scream again.] Then, give the kid a mirror to watch. Describe how you are going to give an injection that might feel like a little pinch, like this [as you give the back of his hand a little pinch]. Then with the kid watching in the mirror, you should be able to administer the local injection. After completing the procedure, shake hands and praise the kid for being such a good patient.

You and the parent will be surprised when the kid returns for the next appointment and walks into the operatory like a trooper, so proud that he or she is no longer afraid. Yes, it doesn’t work all the time. But isn’t it worth a try? Isn’t it better to avoid the risks of sedation and general anesthesia, which do not allow the learning experience of HOM?

And, by the way, it might also work on those screaming politicians trying to scuttle Medicaid and Medicare. At least it’s worth a try.

Jay W. Friedman