Chapter 4: Psychological Features And Behavior Managment Flashcards
Common features in children:
- individuality
- fear of abandonment
- awareness of time/concept of time
- fear of the unknown
Children younger than 2-3, parents should?
Stay in the room
Up until what age are children not aware of time?
Younger than 4 years old
Behavior management is necessary to?
Gain confidence of the child
Factors affecting the child behavior?
- family’s attitude
- IQ and age
- previous experiences
- presence of parents in the dental office during treatment
- time and extension of the visit
How do we achieve effective treatments?
We don’t change an expected treatment to the detriment of health, based on the child’s behaviour
Ex: make an extraction instead of a pulpotomy due to bad behavior
how do we achieve efficient treatments?
To do the correct treatment in the shortest possible time
What does a positive attitude towards dental treatments mean?
The child wants to come back
Control behavior techniques include?
- communication techniques
- behavior modification techniques
- movement restriction techniques
- prohibited techniques
- other techniques
What is the key to direct behavior and to creat a trusting relationship with the patient?
Communication
Communication can be?
Verbal or nonverbal
Communication techniques include:
- paediatric language
- play therapy
- control of voice
- tell-show-do
Paediatric language:
- speak at the level of the child’s age without underestimating their intelligence
- never lie
- dont prepare the child TOO much
- encourage their imagination and make comparisons
- avoid silence
- few instructions at a time
- dont allow them to delay treatment
- avoid words that inspire fear
Control of voice: the authoritarian attitude aims to
Reestablish communication that has been lost
We achieve that with a sudden change of tone accompanied by a facial expression, and once we recover their attention, they’ll be praised
What is the basic method in the educational phase of the paediatric patient, and also in any teaching technique? and what does it serve
Tell-show-do
Serves to familiarise the patient with the clinical environment, should be done without any interruptions and caring language, say and do immediately
Behavior modification technique: objective?
To transform inappropriate behavior into an appropriate one
Behavior modification techniques: types?
- reinforcement
- desensitisation
- imitation
RID
Reinforcement: based on?
Pavlov’s laws: a rewarded behavior tends to appear frequently and a punished behavior tends to disappear
Reinforcement: we only apply what kind of reinforcement?
Positive
We dont use negative reinforcement (punishments)
Reinforcement: how do we deal with inappropriate behavior?
Ignore it
Ex: if the patient vomits, we clean it and continue
Reinforcements have to be?
Consistent and contingent
Consistent: given if they behave well and not given if wrong
Contingent: given immediately
Reinforcement: types? And which one works best?
- social (works best): praise, smiles
- material
- activities
Desensitisation is?
- a classical technique used by psychologist and psychiatrists
- based on reducing anxiety by relaxation and doing everything systematically
- systematically we establish a scale of difficulty of what causes anxiety and we’ll change it gradually, enter clinic-exploration-prophylaxis
- each sequence of treatment should be individualised to each patient
Movement restriction techniques: objectives?
• To protect him/her against possible injuries (prevent the child movements during anaesthesia).
• To make the treatment easier.
• To recover the child’s attention (hold the hand when distracted).
• To teach the behavior expected from him (ex: put his hand here).
• To give him/her more confidence through body contact.
• They should always be associated to behavior modification techniques and their application in
some cases is controversial.
Movement restriction techniques: preliminary considerations?
• Done after conventional techniques (if they don’t work).
• If this method does not work, the next option would be the sedation or general anaesthesia.
• Never do it as a punishment.
• The aim should be to protect the patient, the dentist, and the assistant.
• Written informed consent must be obtained before.
• Peaceful environment, try to generate positive feelings.
• If correctly done it should not leave any sequel.
Movement restriction techniques: indications:
• Children with physical limitations (cerebral palsy).
• Children with mental conditions that can not cooperate.
• Very young children.
• Some premeditated patients, to reduce untoward movement.
• Children with very violent tantrums: spoiled children that are normal but should be controlled sporadically—> potentially cooperative (try to avoid this techniques).
• A patient who requires urgent care and doesn’t cooperate.
Movement restriction techniques: types:
- mouth prep
- physical control by dental team
- physical control by parents
- equipment: auxiliary restriction elements
Movement restriction techniques: physical control by dental team: the physical limitation systems include?
Towels, sheets
Movement restriction techniques: auxiliary restriction elements include?
Sheets
Towels
Seat belts
Full body stabilisation devices: papoose board, pedi wrap
Prohibited techniques:
Hand over mouth: the aim was to restore communication with a child, in case he/she understood what we were going to do.
- not indicated in children under 3 or in patients with mental conditions
Other indications include:
Distraction
Relaxation
Magic
Hypnosis
Acupuncture
Child psychologists
Distraction:
Music, videos, photos, games
Profile of the non-cooperative child: 4 types are:
- fearing child
- shy child
- rebel child
- spoiled child
Fearing child: characteristics:
- They can not overcome their fear.
- They react in an exaggerated way to normal stimuli.
- Bad previous experiences.
Fearing child: professional action
- Make a practical demonstration of what is going to be done.
- Sedation or general anaesthesia.
Shy child: characteristics
- Inability to face the situation
- crying (not tantrums).
Shy child: professional action
- Tell-show-do.
- Get trust and good communication.
- Act firmly and affectionately, patience.
Rebel child: characteristic
- They show disagreement with different degrees of aggressiveness.
- Spoiled, rebels, overprotected.
- Rejection of authority.
Rebel child: professional action
show authority and firmness.
Spoiled child: characteristics
Dominant, whiners, rebels
Spoiled child: professional action
Act with authority and decision
Neurodevelopment according to the age: characteristics of a 3 month old
Able to smile and make sounds
Neurodevelopment according to the age: characteristics of a 6 month old
They may be happy, shy, afraid
Play with baby bottle, hands, feet
Start chewing
Hold things with their hands
Neurodevelopment according to the age: characteristics of a 12 month old:
Stops putting objects in their mouths
Crawl
Understands phrases, speaks 2-3 word
Angry if separated from parents
Increase motor skills
Neurodevelopment according to the age: characteristics of a 2 year old
- all teeth in mouth except 2nd TM which is erupting
- inc motor skills
- speaks 15-50 words
- tantrums and negativism
- independence
Neurodevelopment according to the age: characteristics of a 3 year old
Susceptible to praise
Makes friends
1000 words
Neurodevelopment according to the age: characteristics of a 4 year old
Distinguish between left and right.
Bladder/bowel control (toilet training).
Know 2000 words, 4-5 words phrases.
Great talkers and ask why.
Loss of control.
Deal better with parents separation.
Neurodevelopment according to the age: characteristics of a 5 year old
Able to hop on one leg.
Says his/her age.
Distinguish between morning and afternoon. Language established, phrases 5-6 words. Mothers are the center of the world.
Respond to praise
Neurodevelopment according to the age: characteristics of a 6 year old
Can not adapt, tantrums, needs to be right
Language fully established
Neurodevelopment according to the age: characteristics of a 7-8 year old
Cooperators , desire approvals, great intellectual capacity
Tend to dramatise situations
Neurodevelopment according to the age: characteristics of a 9-12 year old
Balanced and cooperative
Neurodevelopment according to the age: characteristics of puberty
Rebellious, interest in hygiene and physical appearance
Behavior management: 1-3 years old
the child doesn’t cooperate and doesn’t understand.
Most useful techniques: voice control and substitutive language.
Behavior management: 3-6 years old
children cooperate but don’t understand the dental treatment.
Useful: tell-show-do, reinforcement, and imitation.
Behavior management: older than 6 years old
may cooperate and understand. We must explain the treatments.
Useful: tell-show-do, reinforcement, and imitation.
