Behaviour management and the child patient

• What is the treatment triangle?

  Child patient ---> Mother ---- > Dental Team
• What are characteristics of a 2 year old?

  - very attached to parent- short attention span- limited and language - can follow simple instructions- fear of loud noises- may exhibit negative behaviour
• What are characteristics of a 4 year old?

  - inquisitive - very legalistic - good imagination - developing and asserting independence
• What are characteristics in late childhood?

  • Less dependent on parents • Identifies with members of same sex • More sophisticated use of language • 7 years 'age of reasoning '• Sense of duty and accomplishment
• What are characteristics of adolescents?

  • Independence and identity formation • Emotional turmoil • Moody and oversensitive to criticism • Miserable for no apparent reason
• What factors are indicative of child anxiety?

  • Previous medical history • Previous dental history • Social history • Awareness of dental problem • Child temperament • Parents!
• What are the different behavior's children can exhibit?

  • Pre co-operative • Potentially co-operative • Co-operative • Lacking co-operative ability
• What are internal factors for child behaviour?

  • Tired • Hungry • Toothache • Uncomfortable • Unwell
• What are external factors for child behaviour?

  • Time of day - Weather • Company • Noise
• How can the parent influence child behaviour?

  • Anxiety • Attitude • Presence
• How does parental anxiety affect child behaviour?

  •Relationship between maternal anxiety and difficulties in child patient management at all ages
• What are the different types of parental attitude?

  • Over-protective • Manipulative • Hostile • Neglectful
• Does parental presence affect children's behaviour?

  • Generally children's behaviour unaffected by parental presence/absence • Except younger than 4
• What is the advantage of having parents present?

  • Silent supporter • Emotional support • Consent • Involved in preventive regimes
• What is the advantage of having parents absent?

  • Reduce communication interference • Eliminate transference of parental anxiety • Dentist more relaxed
• How does the dental team impact child behaviour?

  • Pre-appointment information • Waiting times • Dental environment • Communication • Manner • Structure of appointment • Appointment scheduling
• What is the advantage of the pre-appointment information letter?

  • Useful for parental and child anxiety • Welcome to practice • Photos of staff • Information about what will happen at first visit • Advice on preparing the child • Simple language
• How do waiting times affect child behaviour?

  • Long waiting times have adverse effect on child behaviour • Run on time (organisation is key) • Activities in the waiting room
• What is a good structure for an appointment?

  • Greeting • Preliminary chat • Explanation • Treatment • Health education • Dismissal
• What do you have to consider when appointment scheduling?

  - Timing - Duration - Sequence
• What is the aim of behaviour management?

  • Effectively and efficiently undertake treatment for the child
  • Help reduce dental anxiety
  • Instill a positive dental attitude\Create a long-term interest
• Why do we need behaviour management techniques?

  • improve communication
  • reduce anxiety
  • reinforce or eliminate patterns of behaviour
• Why is non-verbal communication important?

  • Occurs continuously
  • May reinforce or contradict verbal signs
  • Includes child-friendly environment, happy, smiling team
  • Reinforcement (enquiring how child feeling, gentle pats, squeezes) minimises stress
• What do we need to consider when it comes to our language with children?

  • Age appropriate
  • Non-threatening explanations
  • Avoid jargon
• What is voice control?

  • Controlled alteration of voice, volume, tone, pace
  • Used to direct patients behaviour
  • Especially useful in young children
  • Aims to improve attention and compliance
  • Establishes authority
  • Shown to decrease disruptive behaviour's without producing long-term negative effects
• Showing empathy with result in?

  More likeliness to complete treatment
• What is Tell -Show - Do?

  • Tell - age appropriate explanation of procedure
  • Show - demonstrate procedure
  • Do - initiate with minimum delay
• What is the purpose of the stop signal?

  • Enhances control
  • Raising of arm which is rehearsed
  • Respond quickly
• What are types of distractions?

  audio/visual
• What is systematic desensitisation?

  • Helps patients by repeated contacts
  • Hierarchy of fear-producing stimuli constructed WITH patient
  • Exposure in ordered manner
  • Used in conjunction with relaxation
  • Only progress when patient feels comfortable
• What are some coping strategies?

  • More efficacious in older children
  • Staff or parents make coping promoting statements
  • Relaxation, rationalisation
• What is behaviour shaping?

  • Small, clear steps towards desired behaviour
  • Used in conjunction with positive and negative reinforcement
• What is positive reinforcement?

  • Strengthening of behaviour pattern
  • Increases probability of that behaviour being demonstrated again
  • Positive reinforcers e.g. stickers
  • Social/emotional stimuli most powerful
  • Do not reinforce inappropriate behaviour
• What is negative reinforcement?

  • Removal of pleasant stimulus
  • Applied consistently to all actions except required one
  • Selective exclusion of parent
• What are pharmacological techniques for behaviour management?

  • Sedation
  • General Anaesthesia