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Behavior Management I and II

Baraa'h AlSalamat

Ola Bataineh

5-11-2013
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Behavior Management I all the time the dr. didn't mention anything outside the slides outlines : 1- definition 2- importance of behavior management (BM) 3- Fears in children 4- Classification of child behavior 5- Pedo triangle 6- Dental attitudes of parents slide #4 - Definition : a clinical art form & skill built on a foundation of science. ___________________________________ slide #5 - #7 - Importance of behavior : one of the threatening elements is Dental jargon :in general speaking that dentistry is scary or painful. ___________________________________ slide #8 - #14 Fears in children types of fears : 1- Innate fears, ex. a child carried by his mother refuses to be with another one else because he or she is afraid, he hates strangers. caused by slow development or mental retardation and emotional upsets in life 2- Acquired fears , ex your friends tell you that going to the dentist is unpleasant so you have an idea that the dentist is fearful to be with. 3- learned fears, having experience your-self. *fears according to age in the 3-6 year old children: 3 years old : separation fear and visual fear 4years old : auditory fear ex. sound of the drill 5 years old : separation fear disappears, fear of body harm (they will be aware about the instruments could harm) the 3 most feared things in the dental office: 1- LA ( local anesthesia) 2- RD (rubber dam application) 3- HS (high speed hand piece) Factors influencing behavior : Age: as we noticed that it differ from age to age, the fears of the 3 yo child from the fears of 5 yo child Dentist: your approach will affect the child behavior. Maternal anxiety: if the child hasn't have any experiment with the dental office, but his mother have fears of it the child will learn from her, so keeping the mother outside the office will be ok.
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Medical history : usually children who have a positive medical history will have fears of the dentist examination. ex. a child with renal failure he goes to the hospital very frequently so he is siege of people with white coats. Time & length of appointment : they will be good up to 30 min after that they will misbehave, some children will misbehave after 10-15 mins so you have to be careful during your procedure. Awareness of dental problem : some children are aware about their oral health situation and know how long and expensive the treatment is, it make them more feared. Parental attitude : some parents are not dentally aware they will make discussion with you and you will be trying to explain and you will have a complex with them. Culture : different from country to another. some will refuse things and others will accept them. to show the difference between acquired and learned fears : five monkys experiment :

Slide #15 - #22

Classification of cooperative child behavior 1- Wright's classification (a.Cooperative, b.Lacking cooperative and potentially cooperative) 2- Frankl behavioral rating scale (Def. negative "- -" , negative "-" , positive "+" , Def. positive "+ +" ) slide #19 : Potentially cooperative children those children who are misbehave but we can modify their attitude to be cooperative they are 5 types : 1- uncontrolled (hysterical) : 3-6 yo those who enter the clinic and do not even listen to you, he shutdown all the ways to speak to him, continuous screaming and crying may lay down on the ground, so he need pharmacological way of treatment ex. general anesthesia. 2- Defiant : this child would not cry and scream only he will hit you and pushing you away, some time we could control him but without a proper procedure. 3- Timid : very shy and quite all the time but he suddenly became uncontrolled. 4- Tense cooperative : when enter the clinic he is highly tensed body hands and legs, stressed biting on his teeth , this is very common. 5- Whining : when he sets on the chair he starts crying without tears, just sound. ** when we use Frankle behavioral rating scale it is not enough to use just symbols you have to write in bracts what happened for ex. if you have a (- -) patient the reaction could be hostile. what to write in the file is the following : behavior : - , shouting during the procedure ,shy or define the local anesthetic syringe. slide # 23 - #36 Classification of uncooperative child behavior , could be one of them or a combination of more than one. 1- the emotionally compromised child: have emotional illness ex. broken home after parents separate in a non healthy way , or poverty. so dental procedures are difficult for these patients because of these problems. 2- the shy , introverted child: they have problems with contacting people they will not follow the treatment very effectively, because the dental treatment means to them encountering the dentist looking their eyes or they have to talk to them ask them and contact, but he doesn't want to be with any one at all. so this type of patient require rapport and communication and this is very stressful for him. Stress in with this child will lead to avoidance behavior and crying or whimpering (speak with himself) the management : Rapport , trust and communication. sometimes you can break the ice by speaking with them by their level be a friend and patience with lack of communication. THEN suddenly they will open their mouth and let you do the treatment. 3- the frightened child : do the procedure with a very short time step by step until they become more cooperative. 4- the child who is averse to authority he is an overindulged he misbehave anywhere not just in the dental office, extends to become defiant he does not accept any orders from any one even his parents and teachers so here the dentist have to establish authority he is an authoritative figure.
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misdirected goals in life that affect their personality of the child to be superior and their wishes are commands and whatever he wants he gets. so if says i do not want him to treat me. pointing to the dentist. this patient needs attention wants to be the stronger. _________________________________________ Pedo triangle you need to know that when you are in the clinic you need to deal with two sides the patient and his parents. you have to explain what to do to the child in a way and to his parents in another way. and also the child will deal with 2 sides you as an operator and his parents as an emotional support. to act like a victim. Parents also will do the same they are looking at you as the dentist who is treating their child and to the child in different ways depend on the parents (sad, feared,..) you have to deal with lots of emotion inside the clinic. slide #6 - #13: Dental attitudes of parents : four types of parental attitudes can lead to characteristic maladaptive behavior in their child: 1-Overprotective attitude 2-Overindulgent attitude 3-Overauthoritative attitude 4-underaffectionate\ rejecting attitude *there is no any additional notes. slides #14 - #30 Critical moments in dental appointment: 1- separation from parent : when the child come to the clinic without his parents or to set on the chair, children between 3-4 years old parents could enter the clinic with his parents, after that they are not allowed if it is not necessary. 2- Getting into the chair : sometimes the chair is high for some child you need to pick him up , good beh get seated by them-selves. 3- Dentist seated at chair: the dentist try to set on the chair in front of him means that the treatment is inevitable, the good child will accept that and will set by his own but bad one will not. 4- The injection : the most feared and most children know that after they seated and been in supine position the next step is the needle to inject. you have to learn how is the behavior management for local anesthesia bcz you are doing PRR in the clinics to the patient. - you never lie about the needle, if he asks is there a needle ?? you do not say YES! , No; actually we are going to blow a balloon for you. - if he asks will the injection hurt? you will feel a little bit. - if the child start to move small acceptable movement, you need firm voice control "please stay with me! open your mouth! I need you to keep your mouth open!!" in a serious way and not stop giving the local anesthesia directly if the access is clear you go and inject. if you delay it he will keep on delaying and you will keep on delaying and you will never get there and behavior will become even worse. Most of the time the child is afraid of inserting the needle after that he doesn't care! most of the time.
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- do not ever show the needle to the patient, keep your hand hiding under the chair when you want to inject, and should pass in front of him without seeing it while it passing, he actually cannot see what you are passing between you and your assistant. once you done you get it out and hid it away! after recapping. - it is ok if the child cries during local anesthesia, or just teary. Just carry on! if there is no any problem , the mouth is open and you can see , you can get the needle in there and inject slowly. and the child is stable. - the assistant one hand retraction and the other helps to keep the patient stable without movement, without firm pressure , just in case if he moves to stabilize him. - do not do retraction of the cheek with finer ,avoiding the needle stick injury do it with the mirror. 5- The dental procedure 6- End of the appointment 7- Return to the parents Done by : Baraa'h AlSalamat Sorry for being extremely late!! and for any mistake