Behaviour managment

Question 1

technique to develop rapport with child

Answer 1

• Eye contact
• Talk to the child
• Non-verbal communication
• Friendly environment
Dispel fear of the unknown

Question 2

Eye contact-

Answer 2

a child who avoids eye contact is not fully prepared to co-operate
Start with a compliment and catch her eye
May need to gently say ‘look at me’

Question 3

Talk to the child

Answer 3

Ice breakers ‘how old are you’ who have you brought with you?
Ask open questions to promote response
Topics of conversation

Question 4

Behvaiour management technique

BND- PAVEMENTS

Answer 4

Preparing information
Non-verbal communication
Voice control
Tell-show-do
Behaviour shaping and positive reinforcement
Negative reinforcement
Systematic desensitisation
Enhancing control
Distraction
Modelling
Empathy
Coping strategies
Alternative treatment

Question 5

Preparing information

Answer 5

Allay parental anxiety
Welcoming/pre-appointment letter
Recptionist

Question 6

Voice control

Answer 6

Tone pitch pace
Catch attention
Establish authorit
Useful inattentive but communicative children
Not useful if child to young or has inteleticaul/emotional impairment

Question 7

Behaviour shaping and positive reinforcement

Answer 7

Invlove tell,show,do approach
Desired behaviour encouraged and rewarded
A pattern of behaviour is strengthened to increase the probability of reoccurrence
Use positive reinforcement- rewards sticker badges
Social stimuli- facial expression, postivitve voice modulation, verbal praise (be specific)

Question 8

Systemic Desensitization

Answer 8

Useful for patient who can clearly identify their fear and who can communicate
Graded exposure from simple to difficult procedure sequential treatment planning

Question 9

Distraction

Answer 9

Audiovisual- effective in older children

Short term distractions
Pulling lip during LA
Rasing legs to stop gaging during radiographs
Verbal distractions
Dental nurse stroking child’s hand during LA

Question 10

Empathy

Answer 10

Recognise feelings and concerns

Respond to concerns effectively

Question 11

Alternative techniques

Answer 11

Magic tricks
Motivational interviewing- Adolescent ambivalence
Memory restructuring- positive memories of the dental team
hypnosis

Question 12

Coping strategies

Answer 12

Older children-cognitive coping atrategies
Diaphramatic breathing
Progeressive muscle relaxation
Rationalisation
Setting and manageing goals

Younger childre- emotional coping strategoes- crying.singing

Question 13

Types of cry

Answer 13

Singel tear/pain - get LA right
Obstinate- ‘you are not getting that done
Frightened- you are probably going to fast
Compensatory- to drown out the drill (coping strategy) check by asking ‘are you crying because you dont like the noice’

Question 14

Modelling

Answer 14

Live/video
Using coping model rather than a mastery model
Same age
Showing positive outcome leading tor ewards and be praised
Useful for all patients

Question 15

Enchancing control

Answer 15

Stop signal
When to use- not too early on, restorations, intensely distressful procedures fear of choking
Counting down

Question 16

Non verbal communication

Answer 16

Facial expression- smiling
Getal pats and squeezes
Eye contact
Lower level to childs
Open body language

Question 17

Tell show do?

Useful when?

Answer 17

Describe the proceure
Demonstrate
Do
E.g we are going to polish your teeth with the buzzy brush, here is the buzzy brush, see how it tickles yur finger. Now we tickle your teeth with it

Useful for patients who can communicate with low level anxiety, esp new patients without previous experience

Question 18

Negative Reinforcement

Answer 18

Strengthen of a behaviour pattern by the removal of an unpleasant stimulus ( a negative reinforcement) as soon as the required behaviour is exhibited

Should not be confused with punishment
consent needed

Question 19

HOM technique

Selective exclusion of the parent

Answer 19

• placing a hand over the mouth of a crying child and advising the hand will be removed once the child is calm. Removal of the hand and praise given if the child co-operate

Eg when inappropriate behaviour is exhibited the parent is asked to leave. When appropriate behaviour is exhibited the parent is asked to return, thus reinforcing the behaviour

Question 20

A little bit more on communication

Answer 20

Never make promises you cannot keep
Avoid inappropriate reassurances
Avoid non-dental chat
Ask for feedback- how they feel, and feed back about their behaviour
Consider receivers frame of reference (internal)- child’s perspective
Appropriate channel of communication- talk about rubber dam- smell it touch it, fell it, taste it
Repeat messages in slightly different way
Clear instruction- be specific
voice