Paeds - Behavioural Management Flashcards
What questions do we ask when establishing dental fear in children during history taking? (3)
Ask about previous dental treatment
Ask about past experiences - good and bad
Ask about any problems relating to trust/vulnerability
What fears has a 2 year old developed? (4)
Fear of unexpected movements
Fear of loud noises
Fear of strangers
Fear of the dental situation.
list the behavioural developments of a 3 year old (3)
Less fear of separation from parents but might not want to be separated
Don’t separate from parent at this age.
Reacts favourably to positive comments (i.e. to behaviour and clothes)
Experience will dictate reaction to experience
list the fears and developmental milestones of a 4 year old. (5)
Fear of the unknown and bodily harm
Less fearful of strangers (not always the case)
Will respond well to positive reinforcement if parent is present
Have to be kind but firm with instructions
Assertive - bossy and aggressive
list the behavioural developments of a 5 year old. (4)
Less fearful.
Readily separated from parents but wouldn’t until you have established a good relationship
Proud of possessions, this is a way to engage with the parent.
Establish a rapport with comments about clothes
List the behavioural developments of a 6 year old (4)
If child develops a sense of inferiority or inadequacy behaviour may regress to that of a younger age
Seeks acceptance - success in this can affect self esteem
Do not belittle (much more important at this age)
Important to chat with the child at this age
describe fear in 7 year olds? (3)
Have fears but are better at managing them
Question inconsistencies
Conform to rules of society
i.e. boys want to hide the fear will say they have a sore tummy, need the toilet etc.
define dental anxiety.
Occurs without a triggering stimulus and may be a reaction to an unknown danger or anticipatory due to previous negative experience or due to parental preparation or past medical experiences.
define dental fear
Normal emotional response to objects to situations perceived as genuinely threatening i.e. needle or sound of the drill.
define dental phobia
Clinical mental disorder where there is persistent and extreme fear of objects or situations with avoidance behaviour and interference of daily life.
what physiological & somatic sensations are signs of fear? (4)
Breathlessness
Perspiration
Palpitations
Feelings of unease
Tell them that this is a normal response for someone who is worried/nervous
what cognitive features are signs of fear?(4)
Interference in concentration
Hypervirgilance (looking around all the time)
Inability to remember certain events whilst anxious
Imagining the worst outcome
what behavioural reactions are signs of fear? (3)
Avoidance i.e. postponing or disruptive behaviour to stop the treatment
Escape
Aggressive behaviour (especially common in adolescents if they feel they haven't been listened to. Explain that you wont do anything until you have discussed how they are feeling, dentistry comes secondary to their emotions.
how would a young child show that they are dentally anxious/fearful?
Delay by asking lots of questions
how would school aged children show that they are dentally anxious/fearful?
Complain of stomach aches
Need the toilet frequently
how would older children show that they are dentally anxious/fearful? (3)
Complain of headaches and dizziness
Fidgeting
Stuttering
what strategies can you use during treatment to overcome dental fear and anxiety? (4)
address the cause of the worry and reassure them.
Rest breaks
Stop signals
Provided them with all the information they require/want
what are ways that the dentist can reduce anxiety? (8)
Prevent pain Being friendly Establish trust Work quickly Be calm Give moral support Be re-assuring about pain Empathy
what expressions should we look out for in terms of children in pain? (4)
Screwing up the eyes
Lowering the eyebrows
Mouth open
Squarish appearance
what expressions should we look out for in terms of children who are fearful? (4)
Wide eyes
Raised eyebrows
Mouth open
Tense
what is the role of the parent when treating a dentally anxious child? (3)
Children under the age of 4 behave better with a parent present.
Good for parent to see how the child behaves - important if child needs referral
Parents used for knee to knee techniques
list behavioural management techniques. (8)
Positive reinforcement
Tell, show, do
Acclimatisation
Desensitisation
Voice control
Distraction
Role modelling
Relaxation/hypnosis
define positive reinforcement.
Presentation of a stimulus that will increase the likelihood of a behaviour being repeated
Reinforce positive behaviours by giving praise.
what forms of positive social reinforcers can we provide?
Facial expression
Verbal praise has to be specific!!!
Appropriate physical contact
what forms of positive non-social reinforcers can we provide?
Stickers
Colouring poster
Clever certificates
describe tell, show, do.
used to familiarise the child with a new procedure
T = age appropriate explanation
S = Demonstrate aspects of the procedure in a non-threatening setting
D = initiated with minimal delay
define acclimatisation.
A planned, sequential introduction of the clinical environment, people, instruments and procedures.
Gradual introduction.
list useful acclimatisation tips. (4)
Introduce 3:1, suction and cotton rolls on the visit before you fissure seal.
(water in a cup and let child use the suction, 3:1)
Introduce topical for one visit before using LA for the first time
Give rubber dam home on the visit before its use.
Use the slow speed on finger nail with a trophy cup, then with a slow speed bur
describe the use of voice control.
A controlled alteration of voice volume, tone or pace to influence and direct the patients behaviour.
Gain attention/compliance
To avert negative/avoidance behaviour
name examples of distraction techniques. (3)
Pulling the upper lip
Telling a story (i.e. whilst giving LA)
Bringing music to listen to
describe the role modelling technique
Having the patient watch a person of similar age (sibling) undergoing similar treatment with ease.
what age of child does role modelling work best for?
3-5
name types of relaxation exercises that can be used to moderate behaviour. (2)
The Space Exercise:
Get child concentrating on breathing in for 3, out for 5.
Practice yourself
Progressive Muscle Relaxation:
Tensing and relaxing the muscles
