Can birth order affect temperament, anxiety and behavior in 5 to 7-year-old children in the dental setting?

Aim: The aim of this study was to evaluate the relationships between birth order and child's temperament, anxiety and behavior in the dental setting.

Materials And Methods: A total of 200 healthy children aged 5 to 7 years, were included in this double-blind randomized controlled trial. The study consisted of two sessions. In the initial appointment, parents were provided with instructions and asked to complete children's behavior questionnaire (CBQ). In the second appointment, identical dental treatments were rendered to all subjects. During treatment, Frankl scale for child's behavior, facial Image scale (FIS) for situational anxiety, and clinical anxiety rating scale for clinical anxiety were utilized. Analysis of data was done using U Mann-Whitney and Kruskal-Wallis tests.

Results: Only children had higher clinical (p = 0.041) and situational (p < 0.001) anxiety, and more negative behavior (p = 0.013) compared to children with siblings. In children with siblings, first-born child was in increased risk of developing negative behavior (p = 0.008), clinical anxiety (p < 0.001) and situational anxiety (p = 0.006). With an exception (sadness, p < 0.001), no significant differences in temperament scale were observed among children with different birth orders.

Conclusion: According to the results, only children and laterborns are at higher risk of developing worse outcomes in the dental setting.

Clinical Significance: The role of birth order has been ignored as a possible factor of behavior during routine dental treatment and these findings may shed light on our understanding of behavior management strategies in the dental setting. Considering the increasing pattern of family with an only child both in modern and developing countries, this is more likely that the dental team will face children with negative outcome during dental treatment.