Child Development and Behavior Mgmt Flashcards
What quality in children is associated with of successfullness in life?
Resiliency.
What is the maturational theory of child development?
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
Psychosexual Theory of child development? Who? Describe?
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
What are the 5 theories of child development?
- Maturational theory (18th Century Hal and Gesell) development is genetic/internal
- Psychosexual Theory-Freud Mommy/Daddy issues
- Behaviorism Pavlov/Watson/Skinner: environment changes behavior
- Social Learning theory- derived from behaviorism children learn from social environment
- Cognitive Theory: Jean Piaget- Children think differently than adults, proceeding through distinct stages and environment interactions
Describe Behaviorism Theory of child development
Pavlov/Skinner/Watson
- Environment is the source of behavioral change
- Patterns of reinforcement
- Conditioning
- Stimulus-response
- Rewarded behaviors stay and punished behaviors extinguish
The environment interaction is emphasized by which theories of child development? Which theories does it not play a role?
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)
What theory is derived from behaviorism? How is it different?
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
Application of behavioral techniques: what are important for clinical dentistry?
- 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)
Describe the cognitive theory:
- 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
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
- 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)
Percent of children with language/speech delay? What are some possible causes?
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
How does temperament impact child dental fear?
- Shy children are greater risk for dental fear, and longer duration of feeding habits
- Children w/difficulty regulating emotion are at greater risk
Define “Effortful Control”
Modification of one’s own behavior
Can be exercised by 12 months of age
a “self soother” (blanket, pacifier, thumb)
Fear at ages 1-2
Fear at ages 3-4
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)
Fear at age 5y
Fear at age 6-8 y
5: decrease in fears
6-8years: failure at school, death of a loved one, ridicule (social fears)
How do gender and age relate to dental fear in adolescents?
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.
Maternal anxiety plays a temporary secondary role. T/F
True
Mother’s perceptions of children: describe their views on their own childrens behavior vs an independent observer
- 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
Nitrous Oxide: Effects: - Anxiety and receptors? - Analgesia and receptors? - nervous system? CVS?
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
Advantages and disadvantages of nitrous oxide?
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
Contraindications to Nitrous oxide? relative contraindications or med consult needed?
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)
What is the Goal, patient responsiveness, physiologic changes, and personnel needed for MINIMAL sedation? How does it differ from MODERATE sedation?
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
What is the Goal, patient responsiveness, physiologic changes, and personnel needed for DEEP sedation?
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
Why is the child’s airway more challenging than the adults?
Different anatomy
Relatively larger tongue/epiglottis
Mandible less developed
Increased airway resistance (ventilation is difficult)
What are some caveats of oral route of administration for sedative medications?
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
Describe the caveats of intranasal route of administration?
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
Describe the caveats of intramuscular route of administration?
- Faster absorption than oral route
- ease of admin
- potential for trauma/pain
- prolonged onset and recovery
- inability to tirate
- increased liability costs
Describe the caveats of IV route of administration?
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
Chloral hydrate: type of drug? Effects? Onset? Duration? Dosage/Max dose? Reversal? Caveats? Precautions?
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
Meperdine (Demerol): type of drug? Effects? Onset? Duration? Reversal? Caveats? Precautions?
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
Demerol/Meperidine : precautions and side fx to be aware of?
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
Hydroxyzine (Vistaril, Atarax): type of drug? Effects? Onset? Duration? Reversal? Caveats? Precautions?
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
Diazepam (Valium): type of drug? Effects? Onset? Duration? Reversal? Caveats? Precautions?
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.
Midazolam (Versed): type of drug? Effects? Onset? Duration? Reversal? Caveats?
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
Versed/Midazolam: potentiated by? Inhibited by? Don’t mix with? Why?
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
Complications of Midazolam?
Paradoxical negativism: 2% of patients, patients becomes agitated, combaitive. Incolsolable screaming/flailing
Lidocaine : effects on CNS/CV? onset? Preop? Toxicity? Precautions w/sedation?
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?
What are the most common adverse events by percent?
Respiratory arrest 43%
Respiratory depression 30%
Cardiac arrest 8%
Desaturation, seizure, laryngospasm less the 5% each
