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Paediatrics > Behaviour Management > Flashcards

Behaviour Management Flashcards

1
Q

How many children display anxiety different to adults

A

More irrational

Less restrained

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2
Q

What is the importance in treating dental anxiety in children

A

Childhood dental anxiety may cause anxiety in adulthood

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3
Q

How do you assess the child when taking a history

A
  • Current Pain
  • Dental History
  • Relevant past medical history
  • Social history
  • Levels of understanding and potential co-operation
  • Levels of anxiety eg. FrankL Behaviour Rating Scale
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4
Q

How can you evaluate patient’s cooperative ability

A
  • Frank L Scale
  • Cognitive level
  • Temperoment
  • Personality
  • Anxiety
  • Fear
  • Whether the child is approachable or shy determines treatment difficulty
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5
Q

Describe FrankL Scale. Number, name, (+/-) and behaviour

A

1 (- -) Definitely Negative

  • Child refuses tx
  • Cries forcefully, fearfully or displays any agitated, overt evidence of extreme negativism
  • Combative, thrashing, verbal, unable to be restrained, need to terminate procedure

2 (-) Negative

  • Reluctant to accept treatment and some evidence of negative attitude but not pronounced
  • Slightly combative, verbal, slightly agitated, able to be restrained and procedure safely completed

3 (+) Positive

  • Child may accept treatment but may be cautious
  • Child willing to comply with dentist but may have some reservations
  • Quiet, not combative, cooperative, nonverbal

4 (+ +) Definitely positive

  • Child has a good rapport with dentist and is interested in dental procedures
  • Happy, helpful
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6
Q

How can children’s behaviour be characterised. How can you manage these patients

A

1) Cooperative
2) Potentially cooperative
3) Lacking cooperative ability (pre-cooperative) eg. very young children and special disabilities

Behaviour management techniques can be used for 1 and 2
GA and sedation might be required for 3

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7
Q

What is the role of the dentist in management of children and why is effective dentist-child communication so important

A
  • Critical in creating a positive environment for child
  • Gains trust between them
  • Improves information obtained from the patient
  • Enables dentist to communicate info to patient
  • Increases likelihood of pt compliance
  • Decreases patient anxiety
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8
Q

What are the main ways of communicating with patients and percentages

A

1) Verbal Communication (5%)
2) Paralinguistics (30%) eg tone of voice
3) Non-verbal communication (65%)

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9
Q

How can dentist reduce child anxiety

A
  • Avoid emotive words
  • Prevent pain
  • Friendly and establish trust
  • Work quick
  • Calm manner
  • Moral support
  • Re-assuring about pain
  • Empathy
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10
Q

How can dentist increase fear related behaviour

A
  • Ignoring or denying feelings
  • Inappropriate reassurance
  • Coercing/coaxing
  • Humiliating
  • Losing patience
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11
Q

DO NOT (with child)

A
  • Bribe
  • Lie
  • Shout
  • Coerce
  • Bully
  • Threaten
  • Allow child to have their own way
  • Inappropriately reassure
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12
Q

What is the role of the parent

A
  • Prepare for a visit to the dentist
  • Dentist should provide parent how to prepare child
  • Rehearsal
  • Supportive care prior to each stressful procedure
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13
Q

What is definition, aim and method of behaviour management

A
  • Behaviour management is the means by which the dentist effectively and efficiently performs treatment for a child
  • Aim is to instill a positive dental attitude
  • Methods are related to communication and education
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14
Q

Name some behavioural management techniques

A
  • Tell show do
  • Positive reinforcement
  • Appropriate language
  • Role modelling
  • Giving the child control (hand signal)
  • Appropriate touch
  • Distraction
  • Reward
  • Acclimatisation
  • Desensitistion
  • Voice control
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15
Q

What is positive reinforcement and egs

A

-Presentation of a stimulus that will increase likelihood of a behaviour being repeated
-Rewards desired behaviour
-Failing to reinforce a behaviour may result in it being eliminated
-Dentist must make it clear what is being rewarded
-Delivered immediately
-Eg. Positive voice modulation
Facial expression
Verbal pause
Thank u for keeping still

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16
Q

What is tell show do

A
  • method of introducing dental equipment and procedures
  • tell child about instrument
  • Show child instrument and describe any sensation that might be felt in positive or neutral terms
  • do what has been demonstrated with minimal delay and in a matter of fact manner
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17
Q

Explain acclimatisation and eg

A
  • Planned sequential introduction of environment, people, instruments and procedures
  • At each appt, child should be introduced to a more challenging procedure
  • introduce topical one visit before using la for the first time
  • give rubber dam home on visit before u plan to use it
  • introduce 3 in 1, suction and cotton rolls on visit before you plan fissure sealant
  • use the slow speed first with a trophy cup, later with a bur and later intro high speed
18
Q

What is systematic sensitisation and how do u do it

A
  • Based on assumption that repeated non-distressing exposure to an anxiety-provoking stimulus will eventually reduce anxiety
  • Construct a hierarchy of anxiety provoking situations
  • encourage them to relax (sometimes with aid of hypnosis)
  • present least anxiety provoking stimulus either in imagination or in real life until no anxiety is produced
  • repeat for next least anxious stimulus
19
Q

what is voice control, aim and examples

A
  • controlled alteration of voice, volume, tone or pace to influence and direct pt behaviour
  • young children often respond to tone rather than words
  • aim to improve attention and compliance as well as gain authority eg abrupt change from soft to loud to gain attention of child who is not complying
  • technique is not appropriate for children too young to understand or with intellectual or emotional impairment
20
Q

how can hand signals be used to enhance control

A
  • provides patient with a degree of control over dentists behaviour through use of a stop signal
  • shown to reduce pain during routine dental tx
21
Q

what is distraction technique, aims and examples

A
  • Aims to shift patient attention from dental setting to another situation or from a potentially unpleasant procedure to some other action
  • verbal distraction eg. dentist who talks while applying topical paste and administering la
  • short term distraction eg diverting attention by pulling lip as local anaesthesia is given or have patients raise legs to stop gagging during radiographs
22
Q

what happens if more than behaviour management is needed

A
  • ga
  • oral sedation if simple sextant extraction
  • nitrous oxide
  • iv sedation
23
Q

what is nitrous oxide sedation, how is it administered, what is the mean age used for, severity of anxiety used

A
  • inhalation sedation
  • 6-11 years
  • successful in mild to moderate anxiety
  • treatment completed in 3-10 sessions, 1-5 months
  • patients demonstrate continued anxiety reduction
24
Q

why may nos fail

A

young age
multiple xlas
irregular attendance

25
Q

objective of nos ihs

A
  • reduce anxiety
  • reduce gag
  • reduce reaction to dental tx
  • increase tolerance for more difficult procedures
  • increase pain threshold
26
Q

indications of nos ihs

A
  • cooperative child undergoing lengthy tx
  • pt with special disability
  • anxious child
  • gag reflex
  • la cannot be obtained
27
Q

when would you use ga to tx a child

A
  • medically compromising condiitons
  • difficult or complex dental tx
  • extractions in multiple quadrants
  • very young children
28
Q

slow handpiece in childreneese

A

mr tickle

29
Q

airroter in childreneese

A

whizzy brush or tooth shower

30
Q

3/1 or inhalation sedation in childreneese

A

magic wind

31
Q

LA in childreneese

A

jungle juice

32
Q

giving LA in childreneese

A

spraying teeth to sleep

33
Q

rubber dam in childreneese

A

umbrella or raincoat

34
Q

clamp for rubber dam in childreneese

A

clip/sparkly ring

35
Q

fissure sealant in childreneese

A

tooth paint

36
Q

suction in childreneese

A

hoover/thirsty straw

37
Q

amalgam in childreneese

A

silver star

38
Q

stainless steel crown in childreneese

A

-soldiers helmet or princess crown

39
Q

composite in childreneese

A

magic white cream

40
Q

fluoride varnish in childreneese

A

superhero toothpaste

Paediatrics (16 decks)

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