Basic Techniques for Management of the Infant and Toddler Dental Patient
Cognitive Development

Cognitive development theories define how the world is seen by the child based on their age. While the age a child reaches a stage may vary, the sequence of development is generally constant among healthy children. There are numerous theories of cognitive development. Jean Piagets’s stages of child development can provide the clinician with a basic knowledge of cognitive development.

Piaget's Stages of Cognitive Development

• Sensorimotor Stage (Birth-24 months): Infant uses senses and motor abilities to understand the world and there is little to no meaningful verbal communication other than single word commands. This is not to say that children are not aware of their surroundings; they are hyperaware of people around them as they reach this age and are perceptive to nonverbal communication. They understand object permanence at this stage.
• Preoperational Stage (2-7 years): Children begin to use language in similar ways to adults and can form mental symbols and words to represent objects. Language is concrete and literal and has limited logical reasoning skills. Children tend to perceive the world from their own perspective or be “egocentric."
• Concrete Operational Stage (7-11 years): Children demonstrate increased logical reasoning skills and can see the world from different points of view. They still have a difficult time with abstract ideas and benefit from concrete instructions.
• Formal Operations (12+ years): Children can think about abstractions and hypothetical concepts and reason analytically.⁴

Thus attempting long verbal explanations to children in the preoperational and concrete operational stages will not influence behavior because of the limitations of the child’s reasoning skills and difficulty to fully understand long verbal explanations of the effect of behavior on treatment. For these age groups, short direct requests and commands are more effective in obtaining desired behavior.