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Pediatric Dentistry Boards > Child Development and Behavior Mgmt > Flashcards

Child Development and Behavior Mgmt Flashcards

1
Q

What quality in children is associated with of successfullness in life?

A

Resiliency.

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2
Q

What is the maturational theory of child development?

A

Maturational theory - 18th centruy-hall and Gesell

  • Development is internally-driven (genetic)
  • Babies are self regulating and self-righting
  • Very little depends on parenting
  • Flaw: study based on upper class children
  • This is the basis for the developmental milestones and age norms that are currently used
  • Temperament does not have a specific role
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3
Q

Psychosexual Theory of child development? Who? Describe?

A

Freud

  • Emotional life influences behavior and development
  • Emotion, dreams, feelings, and frustration matters
  • Interactions between parent and child influence personality, resiliency, behavior, adjustment
  • Children have an active mental life before speech
  • Emotional past can help assess current behavior
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4
Q

What are the 5 theories of child development?

A
  1. Maturational theory (18th Century Hal and Gesell) development is genetic/internal
  2. Psychosexual Theory-Freud Mommy/Daddy issues
  3. Behaviorism Pavlov/Watson/Skinner: environment changes behavior
  4. Social Learning theory- derived from behaviorism children learn from social environment
  5. Cognitive Theory: Jean Piaget- Children think differently than adults, proceeding through distinct stages and environment interactions
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5
Q

Describe Behaviorism Theory of child development

A

Pavlov/Skinner/Watson

  • Environment is the source of behavioral change
  • Patterns of reinforcement
  • Conditioning
  • Stimulus-response
  • Rewarded behaviors stay and punished behaviors extinguish
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6
Q

The environment interaction is emphasized by which theories of child development? Which theories does it not play a role?

A

Environment based theories:
1. Behaviorism, Social Learning theory, Cognitive theory
Environment does not play a role in Maturational theory (genetic/internal) or psychosexual theory (emotional/parents)

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7
Q

What theory is derived from behaviorism? How is it different?

A

Social Learning theory is based on behaviorism

  • social context provides feedback on behavior
  • Integration of internal processes and environment
  • development is a series of upward spirals
  • social experiences provide feedback for future development
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8
Q

Application of behavioral techniques: what are important for clinical dentistry?

A
  • Link behavior and consequence
  • consistency
  • Timing (the younger the child is the closer the behavior has to be reward or consequence)
  • Rewards better than punishment (social/interactive rewards like smile and praise are the best)
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9
Q

Describe the cognitive theory:

A
  • Children think differently than adults
  • Cognitive development proceeds in stages based on age
  • Children learn through interaction with the environment
  • Children are active learners not passive responders
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10
Q

What are the Piagetian Stages of Cognitive development at each age group? What are the ways children understand at each age group?

Birth- 2yo
2 - 6yo
6-11yo
>12yo

A
  • Sensorimotor = Birth-2: Direct sensations
    Preoperational = 2-6y: Own perceptions (learns to represent objects with words/drawings, egocentric, magial beliefs).
    Concrete Operations = 6-11y: Reason using stable rule system (appropriate use of logic, solve problems that apply to actual objects, elimination of egocentrism)
    Formal operations >12 = Abstract thought, can reason about ideas (capable of abstract thought, capable of hypothetical reasoning)
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11
Q

Percent of children with language/speech delay? What are some possible causes?

A 
3-10% of children
3-4x more common in boys
Causes:
- mental developmental delay > 50% have language/speech delays
- hearing loss
- maturation delay "late bloomer"
- bilingual - temporary delay only
- psychosocial deprivation- poverty related
- ASD
- CP
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12
Q

How does temperament impact child dental fear?

A
  • Shy children are greater risk for dental fear, and longer duration of feeding habits
  • Children w/difficulty regulating emotion are at greater risk
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13
Q

Define “Effortful Control”

A

Modification of one’s own behavior
Can be exercised by 12 months of age
a “self soother” (blanket, pacifier, thumb)

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14
Q

Fear at ages 1-2

Fear at ages 3-4

A

Fear at 1-2:
- large movements, loud sounds, changes in location of familiar things, strangers, separation (summary: changes)
Fear at 3-4:
- Animals, imaginary creatures, dark, being alone, physical harm (summary: alone, being hurt)

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15
Q

Fear at age 5y

Fear at age 6-8 y

A

5: decrease in fears

6-8years: failure at school, death of a loved one, ridicule (social fears)

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16
Q

How do gender and age relate to dental fear in adolescents?

A

Older girls have more dental fear (ex 15 yo need resto)
Older boys underplay their concerns (holding it all in)
Fearful adolescents may be more difficult.

17
Q

Maternal anxiety plays a temporary secondary role. T/F

A

True

18
Q

Mother’s perceptions of children: describe their views on their own childrens behavior vs an independent observer

A
  • mothers see more negative behavior in other children
  • mothers classified less of their own children’s behavior as negative than did independent observer
  • mothers generally underrate all negative behaviors
19
Q 
Nitrous Oxide:
Effects:
- Anxiety and receptors?
- Analgesia and receptors?
- nervous system? CVS?
A

Fx:

  • Anxiolytic: activation of GABA-A receptor through the benzodiazepine binding site
  • Analgesic: initiated by neuron release of endogenous opiod peptides, activation of opiod receptors, GABA-A receptors and noradrenergic pathways
  • Mild CNS depression
  • Maintenance of blood pressure: only minor depression of cardiac output w/slight increase in peripheral resistance
20
Q

Advantages and disadvantages of nitrous oxide?

A

Advantages:
- Rapid onset, recovery
- Ease of tiration, especially in a calm patient
- Lack of serious side effects
- can be used w/communicative behavior mgmt techniques (making them more effective)
Disadvantages:
- weak agent, depends on pt acceptance, pt must be able to breath thru nose, potentiates fx of other sedatives, occupational hazards, may cause nausea/excitement (in 1-10% of pts), diffusion hypoxia may occur

21
Q

Contraindications to Nitrous oxide? relative contraindications or med consult needed?

A

Contraindications: COPD, 1st trimester of pregnancy
Relative contraindications: acute otitis media, severe asthma, sickle cell disease (has been shown to cause neuropathy), and bleomycin sulfate therapy (anti-neoplastic antibiotic)

22
Q

What is the Goal, patient responsiveness, physiologic changes, and personnel needed for MINIMAL sedation? How does it differ from MODERATE sedation?

A

Minimal Sedation:
- decrease anxiety, facilitate coping
- More calm, interactive, Aware of but less responsive to clinical stimuli
- No loss of protective reflexes, normal vital signs
Personnel needed= 2
**All are the same

23
Q

What is the Goal, patient responsiveness, physiologic changes, and personnel needed for DEEP sedation?

A

Goal: eliminate anxiety, OVERRIDE coping skill
Responsiveness: Uneasily aroused, noninteractive, unaware of and minimally responsive to clinical stimuli
Physiologic change: partial or complete loss of protective reflexes, stable and minimally or moderately below health status norms
Requires THREE people

24
Q

Why is the child’s airway more challenging than the adults?

A

Different anatomy
Relatively larger tongue/epiglottis
Mandible less developed
Increased airway resistance (ventilation is difficult)

25
Q

What are some caveats of oral route of administration for sedative medications?

A

Most common route

  • easily accepted, no injections
  • prolonged onset and recovery
  • relatively safe if using only one drug
  • less predictable
  • first pass hepatic metabolism
  • inability to titrate
26
Q

Describe the caveats of intranasal route of administration?

A

Rapid onset,
use atomizer
inability to titrate
Use lower dose-no 1st pass metabolism; nasal mucosa links straight to CNS > leads to plasma levels similar to IV

27
Q

Describe the caveats of intramuscular route of administration?

A
  • Faster absorption than oral route
  • ease of admin
  • potential for trauma/pain
  • prolonged onset and recovery
  • inability to tirate
  • increased liability costs
28
Q

Describe the caveats of IV route of administration?

A

Optimum route

  • rapid onset, drugs can be titrated to achieve desired effect
  • venipuncture complications-hematoma
  • IV access available in case of emergency
  • requires highest level of monitoring and has highest liability costs
29
Q

Chloral hydrate: type of drug? Effects? Onset? Duration? Dosage/Max dose? Reversal? Caveats? Precautions?

A

Non-barbituate sedative hypnotic, muscle relaxant

  • no analgesic or anxiolytic effects
  • onset 30-60 minutes
  • Duration 5-8 hours
  • Dosage: 25-50mg/kg to 1 gm maximum
  • No reversal agent
  • Given orally or as a suppository
  • Unpleasant taste, gastric irritation
  • metabolized by liver/excreted by kidney
  • patient is sleepy when sedation is effective
  • Precautions: potentiates coumadin, deaths
30
Q

Meperdine (Demerol): type of drug? Effects? Onset? Duration? Reversal? Caveats? Precautions?

A

Narcotic, Analgesic, Sedative, Anti-spasmodic

  • Unpleasant taste
  • Admin oral or parenterally
  • CNS, CV and respiratory depression
  • Onset 30 minutes
  • Duration 2-4 hours
  • Dosage: 1-2 mg/kg to max 50mg
  • Reversal : Naloxone
  • Metab by liver, excreted by kidney
  • Lowers seizure threshold, especially with local anesthesia: consider lower dose of LA
31
Q

Demerol/Meperidine : precautions and side fx to be aware of?

A

Precautions:
- Patients w/Asthma (can cause histamine release do not use for them),
- Patients w/seizure disorders(lowers seizure threshold),
- patients w/hepatic disease,
- patients w/renal disease
Side FX: hypotension, respiratory depression, emesis, dizzines, seizures, xerostomia

32
Q

Hydroxyzine (Vistaril, Atarax): type of drug? Effects? Onset? Duration? Reversal? Caveats? Precautions?

A

Antihistamine, anti-emetic

  • Analgesic
  • CNS Depression
  • Used w/other meds
  • Onset 15-30 minutes
  • Duration of 2-4 hours
  • Dosage 1-2mg/kg orally
  • Effect similar to nitrous oxide
  • pleasant taste
33
Q

Diazepam (Valium): type of drug? Effects? Onset? Duration? Reversal? Caveats? Precautions?

A

Benzodiazepine

  • Anxiolytic, amnesic, muscle relaxant
  • CNS depression
  • Minimal CV, respiratory effects
  • Onset 45-60 min, peak 60 minutes
  • Duration 6-8 hours, 1/2 life 20-40 hours
  • Dosage: .25-.3mg/kg
  • Reversal : flumazenil
  • Contraindications: patients with narrow angle glaucoma
  • minimal adverse reactions, wide therapeutic index
  • Precautions: Potentiated by erythromycin, tricyclic antidepressants, valproic acid. Will Increase Digoxin levels.
34
Q

Midazolam (Versed): type of drug? Effects? Onset? Duration? Reversal? Caveats?

A

Benzodiazepine

  • Anxiolytic, anticonvulsant, muscle-relaxant
  • CNS depression
  • minimal CV, respiratory effects
  • Onset 5-10 minutes
  • Duration 30 min max
  • Oral dosage .25-.75mg/kg to 15 mg max
  • Reversal Flumazenil
  • Ideal emergency sedative
35
Q

Versed/Midazolam: potentiated by? Inhibited by? Don’t mix with? Why?

A

Potentiated by Erythromycin, andtifungals (ketaconazole), antacids (cimeridine), grapefruit juice
inhibited by: Phenytoin, anti-TB (rifampin)
Do not mix with grapefruit juice- intereferes w/cytrochrome in liver

36
Q

Complications of Midazolam?

A

Paradoxical negativism: 2% of patients, patients becomes agitated, combaitive. Incolsolable screaming/flailing

37
Q

Lidocaine : effects on CNS/CV? onset? Preop? Toxicity? Precautions w/sedation?

A 
CNS depression
MInimal CV effects
4mg/kg w/ or w/o vasoconstrictor
Anesthesia onset 5 minutes
Pre-op: calc max dose for each patient
Toxicity w/intravascular injection
Overdose appears as seizure
Potentiates other sedative?
38
Q

What are the most common adverse events by percent?

A

Respiratory arrest 43%
Respiratory depression 30%
Cardiac arrest 8%
Desaturation, seizure, laryngospasm less the 5% each

Pediatric Dentistry Boards (23 decks)

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