Growth and Development Flashcards
what happens in baby clinics
weighed
height taken (length lying down)
head circumference measure
check meeting milestones
jaw relationships at birth
Gum pads widely separated anteriorly - gap
Tongue resting on lower gum pad
Tongue in contact with lower lip
- Later, rest behinds teeth
sequence of eruption of primary teeth (basic)
From anterior to posterior
As a general rule mandibular tooth erupt before maxillary
Eruption begins at 6 months
Eruption of deciduous dentition is in most cases complete by 24 months of age
But wide variation
5 characteristics of primary dentition
Incisors upright Incisors spaced Teeth are smaller Reduced overjet More white in colour
5 areas in psychology of child development
Motor Cognitive Perceptual Language Social
motor development in children
Predictability of early “motor milestones” suggests that it must be genetically programmed.
Completed in infancy
- changes following the ability to walk are refinements.
- Post 14 months
Eye-hand coordination gradually becomes more precise and elaborate with increasing experience.
4 stages in cognitive development in children
sensorimotor
preoperational thought
concrete operations
formal operations
sensorimotor stage of cognitive development in children
Until about 2 years, prime achievement is object permanence
- Infant can think of things as permanent and still existing when out of sight
- Can’t think of objects without actually having to see them
preoperational thought stage of cognitive development in children
2 to 7 years.
Allows child to predict outcomes of behaviour.
- Facilitated by language development.
Thought patterns are still egocentric
- unable to see another person’s point of view.
Unable to understand why areas and volumes remain unchanged even though their shape or position my change.
concrete operations stage of cognitive child development
7 to 11 years.
Able to apply logical reasoning and consider another person’s point of view.
- Important for dentist – see other perspectives explain to child e.g. how happy parent will be if they sit nicely
Thinking is rooted in concrete objects
difficult to think in a more abstract manner
formal operations stage in cognitive development of children
begins at 11 years
beginning of logical abstract thinking so that different possibilities for an action can be considered.
perceptual development of children
Difficult to know what babies are experiencing perceptually.
- Most research looks at eye movement.
Compared to an adult a 6 year old will cover less of an object, take in less information and become fixated on details.
Selective attention by 7 years.
language development of children holdbacks (2)
A lack of appropriate stimulation will retard a child’s learning, particularly language.
- No talking from parent to child – even though one sided, important as baby listening
A child needs language to be able to think about what she/he sees and hears.
1 year old understands
vocab of 20 words
- simple phrases
- relates object to word e.g. toy name
1 year old uses
2-3 words
- repetitive babble
- tuneful jargon
1 year old sounds
b
d
m
2 year old understands
simple commands
- questions
- joins in action songs e.g. incy wincy spider
2 year old uses
vocabulary of 100 words
puts 2 words together
echolalia (copies what you say)
2 year old sounds
p t k g n
3 tear old understands
prepositions (on, under etc)
functions of object
simple conversations
3 year old uses
4 word sentences
- what, who, where
- relates experiences
3 year old sounds
f
s
l
4 year old understands
colours
numbers
tenses
complex instructions
4 year old uses
long grammatical sentences
relates stories
4 year old sounds
v
z
ch
j
9 disorders of speech and language that can occur
Learning difficulties
Cerebral palsy
Autism
Delayed speech and
language development
Head injury
Acquired neurological disorders
Non fluency
Dysphonia
Craniofacial disorder
what is needed for normal speech production
competent airway and articulators (lip, teeth, tongue etc)
normal speech production is classified by (3)
place
manner
voice
cleft type speech qualities
resonance
articulation
nasal emission
velopharyngeal incompetence (VPI)
unable to block off nasal passageway to rest of passageways
unable to have normal speech
oro-nasal fistula
air goes up into nose from oral cavity so can’t make some sounds
unable to have normal speech
class III occlusion
protruding mandible
can cause problem in producing dentate sounds
unable to have normal speech
3 roles of cleft team
assessment
diagnosis
treatment
as early as possible
different people in cleft team (multidisciplinary team)
Speech and Language Therapist
Primary cleft surgeon
Secondary cleft surgeon
Orthodontist
Paediatric dentist
ENT surgeon
Geneticist
Nurse
Psychologist
initial treatment of clefts
Feeding
- Can’t be breast fed as unable to have suction from lips
Early intervention
Input modelling
Articulation therapy
when would cleft lip surgery tend to be
3 months
secondary cleft surgery can be
Nasal revision
Fistula closure
-Secondary hole in palate due to surgery
Pharyngoplasty
Alveolar bone graft
- At cleft site to allow permanent teeth to erupt
Osteotomy
2 types of non cleft VPI
bifid uvula
no uvula
(both cases back of palate wrong so unable to have normal speech)
development of feeding skills of infant - pre 40 weeks (in utero)
28 weeks – non-nutritive sucking
34 weeks – nutritive sucking
development of feeding skills of infant - 0-3 months
Normal oral tone
Rhythmical sucking
Primitive reflexes
- Gag
- Rooting
- Suck/swallow
Semi-recline feeding position
Liquid diet
development of feeding skills of infant - 4-6 months
Head control
More control of suck/swallow
Munching
Move towards semi solid diet (UK not recommended to wean till 6 months)
Starts babbling
development of feeding skills of infant - 7-9 months
Sitting feeding position
Mashed consistency
Finger food
Upper lip involvement
Chewing and bolus formation
Bite reflex
Mouthing
development of feeding skills of infant - 10-12 months
Lumpy food
Sustained bite (continuous chewing)
Active lip closure
Chewing – lateralisation
Cup drinking
development of feeding skills of infant - 24 months
a mature and integrate feeding pattern
when does baby start non-nutritive sucking
28 weeks in utero
when does the baby start nutritive sucking
34 weeks in utero
3 considerations to remember when communicating with children
develop natural skills over time
environment conversation happening
its a 2 way process - LISTEN
5 effects of family unit
behaviour contagion
well-intentioned but improper preparation
discuss dental treatment within hearing of the child
-ensure they understand simultaneously or explain to them first
enhancing the child’s anxiety
threatening the child with dental treatment
assessment to be carried out when child pt comes to surgery
pain
past dental history
relevant past medical history
social history
level of understanding and potential co-operation
level of anxiety
what is a knee-to-knee examination
for children under age of 3
not on dental chair
held in patients lap and you kneel in front
3 areas to successful behaviour management
communication
education
interaction
things that frighten children
the unknown
sight of the anaesthetic syringe
sight, sound and sensation of the drill
mutilation
choking
perceived expectation of ill-treatment/ trauma
strangers
- calm and friendly on initial visit
dental anxiety in children prevalence
16% of school-age children are afraid of the dentist and consequently avoid attending
children Vs adult dental anxiety
Children display their anxiety differently from adults
- they are more irrational and less restrained.
There is wide variation between individual children, this may be is largely genetically determined.
Some children who refuse dental treatment have been shown to generally have difficulty adapting to change.
examples of manifestation of anxiety in children
Thumb-sucking Nail biting Nose picking Clumsiness Stuttering Stomach pain Need to go to the toilet Headache Dizziness Fidgeting No speech Clinging to parent Hiding
related to: age, sex, social class
influencing factors on whether child will suffer from dental anxiety
each child’s own psychological make-up
understanding
emotional development
previous adverse dental/ medical experience
- scarring memory
attitude & previous experience of family/ peer-group
the behaviour of the dentist
child interactions DO NOT
bribe coax shout bully threaten allow child to have all their own way
should you show empathy when tx child
yes
create an environment in which the child feels safe
- use a kind empathetic approach using directive guidance, and reinforcement to establish co-operation and obtain a rapport
- allow the child some control (e.g. hand signal)
question for feeling
- are you alright? Are you OK? Are you getting tired?
- show you understand their feeling – acknowledge but move on (know disliked but will benefit it)
good dentist to child communication
Improves the information obtained from the patient
Enables the dentist to communicate information to the patient
Increases the likelihood of patient compliance
Decreases patient anxiety
relate to what they know - films etc
breakdown of components of communication
verbal 5%
para-linguitic 30%
non-verbal 65%
verbal communication
This consists of the actual words the person uses.
Try to avoid the use of jargon and specific terms that the patient might not understand
- Children are not small adults.
The approach and language used with them can be modified to match their abilities and understanding
dental language alternatives examples for children
Cotton Wool Roll’s= Tooth Pillow’s
- Give one to touch and feel
Topical Anaesthetic= Bubble gum or minty gel
Probe= pointer/tooth counter
Excavator= Tooth Spoon
High Speed= Tooth Shower
Slow Speed= “Mr Bumpy”, Tooth Scrubber
Local Anaesthetic= Special Spray, Sleepy Juice
Be careful if autistic – very literal, so don’t use anything that could scare them
use analogies
paralinguistic communication
This refers to the tone of voice used by the individual.
Loudness has been one aspect of paralinguistic communication that has been investigated in the dental field with children.
- It was found issuing commands in a loud voice was more effective than using a normal voice
non-verbal communication
Includes a range of behaviours and environmental factors which we often interpret without conscious awareness
- Facial expression
- Gaze
- Gesture
- Bodily contact
- Clothes
- Spatial
dentist role in reducing child’s anxiety
Preventing pain
Being friendly & establish trust
Working quickly
Having a calm manner
Giving moral support
Being re-assuring about pain
- Avoid using “pain”, “sharp” etc as this is all they will hear
Empathy
dentist role in increasing fear in children
Ignoring or denying feelings
Inappropriate reassurance
- “Nearly done” avoid
Coercing/Coaxing
Humiliating
Losing your patience with the patient
parents role in child’s for dental visit
dentist should advise the parent how to prepare the child for the visit
- a pre-appointment letter,
- rehearsal (if wanted)
supportive care prior to each stressful procedure
can be beneficial to be not in room
beneficial for child for parent to be present?
Research suggests that the child’s behaviour is unaffected by parental presence or absence
The exception would appear to be children less than 4 years of age who have been shown to behave better with a parent present.
when would parents be excluded from surgery child is in
try to in most cases
especially if:
- Unable to refrain from competing with the dentist for their child’s attention.
- Unintentionally convey their own anxieties to their child through body language and words.
Involving the parent in the planning stages and outlining their role as a passive but silent helper may provide a comforting presence (explain your behavior modifying technique so they are not shocked if you raise voice)
what is inclusive parent role in dentistry and when needed
Patient is incapable or unwilling to sit for examination
- positioning the child in the lap of the parent permits the child to be in direct visual and physical contact with the parent (knee-to-knee)
Opportunity exists for the parent to witness the behaviour the clinician must contend with
what is the link between pain and anxiety
Anxious subjects are more likely than non-anxious to report pain
- This points to the psychological role in pain perception
Anxiety, previous experience, expectation, anticipation, communication and control can influence pain perception
how to minimise pain and anxiety in child Tx
Care should be taken not to hurt any child
Restorative care is usually carried out under local analgesia
A painless technique of administering LA is of vital importance - Wand
An introduction to topical and LA is an integral part of treatment (cotton wool roll)
