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3. Paediatrics > Behavioural Management Techniques in Paeds > Flashcards

Behavioural Management Techniques in Paeds Flashcards

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1
Q

Why may a child bite?

A

Only way to stop us being in their mouth

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2
Q

What is out goal with anxious pts?

A

To ensure pt and parent feels engaged and knows how to improve OHI

Ease any fear and anxiety

Promote understanding for need for good dental health

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3
Q

What is communication between dentist and pt built on?

A

Dialogue

FAcial expression

Voice tone

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4
Q

What is important about 2 years olds?

A

Afraid of unexpected movements, loud noises and strangers

dentist is strange and unexpected - we can produce fear at this age as fear is part of evolution to stop children running away

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5
Q

What is important about 3 years?

A

nursery

child wants to be accepted so likes praise on clothes and behaviour

not as scared to be separated from mum and dad

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6
Q

When are solo visits okay if mum and dad stay in waiting room?

A

7-8 years old

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7
Q

What is important about 4 year olds?

A

May be starting school

assertive - tell use what’s happening

fear of unknown, can fear strangers but less if parent present

introduce child to what we are doing in friendly manner

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8
Q

What happens at age 5?

A

Primary school

spends time away from parents, less fears

proud of possessions - good way to engage child

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9
Q

What happens at age 6?

A

Child wants to be accepted - don’t belittle

engage with the child - they know what they want and don’t want so if we cooperate then tx will be easier

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10
Q

If a child won’t open mouth or get on chair how can we manage this?

A

We want to find out why and understand the reasons they don’t want to

Why are you not wanting to sit on my chair?

Would it help if I put back the chair first the you got on?

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11
Q

What happens at age 7-12?

A

Children are growing up - they may be scared but are better at managing

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12
Q

What can anxious boys often do?

A

They may hide

say can’t be bothered

have sore tummy

need toilet

often just avoidance strategies - don’t want to show fear

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13
Q

What 3 things are related?

A

Anxiety, behaviour and compliance

if pt is anxious it affects behaviour which affects compliance

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14
Q

What is dental anxiety?

A

This is what occurs without a present triggering stimulus

may be a reaction to unknown danger or anticipatory danger due to previous bad experiences

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15
Q

What is dental fear?

A

Normal emotional response to objects or situations perceived as genuinely threatning

  • sound of drill, needle
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16
Q

What is a phobia?

A

Clinical mental disorder

pts display persistent and extreme fear of objects or situations with avoidance behaviour and it interferes with daily life

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17
Q

What are the physiological aspects of fear?

A

Out of breath
sweating
palpitations
feeling uneasy - tries to avoid situation

Its important pt knows these are all very normal ways to feel however we can help change this

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18
Q

What do cognitive features of DFA do?

A

They change the way we think - instead of thinking rationally out subconscious brain always thinks of the worst and is unable to remember certain events

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19
Q

How can we manage the cognitive features of DFA?

A

Ensure pt feels in control, let them know nothing will be done without them okaying it!

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20
Q

What are some behavioural aspects of DFA?

A

Avoidance

Escaping situation

being aggressive

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21
Q

How may a pt avoid dentistry?

A

Cancel appt, act disruptively to prevent tx being carried out (Biting, not opening, constant chatter, running out surgery)

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22
Q

If a pt acts aggressive what do we do?

A

Take a step back

inform them that the dentistry isn’t important right now - lets discuss how you feel, I need you to feel comfortable before I start to help you!!

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23
Q

What can subtle DFA present like?

A

Pt asking lots to delay tx

complain of stomach aches or needs toilet lots

headaches, dizzy, fidget, cba

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24
Q

What factors influence DFA?

A

fear of choking

fear of injections

fear of drilling

fear of unknown

past med and dent experiences

dental exp of friends and fam

attitudes of parents towards dental experience

prep at home before dental visit

Childs perception that something is wrong with their teeth

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25
How do we calm DFA?
Give control back to pt
26
How do we give control back to pt?
Stop signals rest breaks answer any qs pt has
27
How do we establish if a pt has dental fear?
Ask about previous dental tx, experience they had, how they feel about dentistry now
28
What is the MCDAS?
This is a quick easy to use questionnaire that a pt completes about how they feel towards different aspects of dentistry - the ratings are of different faces - ranging from relaxed to very worried (covers elements of coming to dentist all the way to a needle, being put to sleep etc)
29
What are the advantages of MCDAS?
Quick Easy to use allows pts to rate diff aspects of dental tx we can establish base line levels of anxiety
30
What does good dentist/pt communicate allow for?
Improved info form the pt about how they are etc enables us to build rapport with pt, we can listen and hear them which inc compliance decreased anxiety inc likelihood of compliance
31
What are the 3 components of communication?
verbal paralinguistic non verbal
32
What is the role of the dentist/pt?
reduce pt anxiety - prevent pain - establish trust - work quickly - be calm - provide moral support - reassure about pain - emapthetic
33
When putting topical LA what can we say to pt to address the way they may feel?
Going to put a little bit of spray in your gum you may feel some light pressure Id be interested t see what you feel
34
What will increase fear related behaviours?
Ignoring or denying feelings - telling kids they are being silly and won't feel anything (MUST ACKNOWLEDGE THEY WILL FEEL SOMETHING!) humiliating pts losing patience - if we feel like happening take a step back and don't continue
35
What is the problem with children and pain?
They may not be able to communicate with us that they feel pain - we must monitor expressions for this
36
What will pain expressions look like?
Screwing up eyes lowering brows mouth in square appearance
37
What does expression of fear look like?
Eyes wide open raised brows mouth open tense
38
What is MTD?
This is known as message to dentist and the pt takes this away with them and fills it out it allows them to fill in how worried they are and how painful they think dental tx will be and what they want to happen and what stop signal they want this allows us to discuss why the pt feels this way and how we can help them cope
39
Is a Childs behaviour affected by parental presence or absence?
No - no evidence to suggest this
40
When would Childs behaviour be better with parental present?
4 OR UNDER
41
Why is parental presence important?
So they can see pt misbehave and not comply with tx - will understand when we refer
42
Why is the parent useful at dental appointments?
If child is too young or won't sit for examination we can do knee to knee exam parents can witness behaviour that we are dealing with
43
What is a knee to knee exam?
Child head in dentist lap and parent holds babies legs on their lap so we can get look inside mouth - baby has contact with parent and can see them
44
What are some BMTs? | 8
Positive reinfircement tell show do acclimatisation desensitisation voice control distraction role modelling relaxation/hypnosis
45
What is positive reinforcement?
This is when we reinforce positive behaviours by either social or non social reinforcers the use of this increases chances of behaviour being repeated
46
What can we use for pos reinforcement?
Facial expression - smile Verbal praise - well done
47
What is important about verbal reinforcement?
It must be specific or child doesn't know what they are being praised for ie well done! that was wonderful when u opened so wide I could see all ur teeth
48
What are some non social reinforcers?
Stickers colouring posters clever certificates
49
When may we tell a child they are clever v giving clever certificate?
Clever - if they do something we expect of them and we want them to repeat this behaviour certificate - if v worried and manage an xla
50
What is the tell show do technique used for?
Used to familiarise pt with a new procedure tell - explain the technique in age appropriate manner show - show them the procedure - ie slow speed on finger nail, suction in cup of water do - carry out technique soon after show (I would now like to do this on ur tooth, is that okay?)
51
What is acclimitisation?
This is where we gradually introduce pt to environment, people, instruments and procedure - done slowly to help get them used to environment and reduce anxiety
52
How do we acclimatise for fissure sealant placement?
Introduce 3 in 1 - hairdryer introduce suction introduce cotton wools
53
How should we acclimatise LA?
Introduce topical one visit before LA
54
What is systematic desensitisation?
This is based on assumption that repeated non distressing exposure to anxiety provoking stimulus will eventually reduce anxiety
55
How do we do systematic desensitisation?
Reassure child they are in control do it in ordered manner from what they perceive as least anxiety provoking to most anxiety provoking until no anxiety is produced
56
What is voice control?
Not used often when e change voice come tone or pace to influence and direct pts behaviour - gian pts attention and compliance avert neg or avoidance behaviour
57
What is distraction?
This is where the divert pts attention from what may be an unpleasant procedure
58
What are some distraction techniques?
pulling upper lip telling story whilst giving LA music you will fell im holding ur lip (inject la as you say this)
59
What is role modelling?
This is where we have presence of sibling with no DFA who is similar age and getting similar tx to act as a coping model
60
What are two relaxation techniques?
Progressive muscle relaxation Space exercise - in for 3 out for 5
61
What is hypnosis?
This is where we try influence subjects perception, feelings, thinking and behaviour by asking them to concentrate on ideas and images
62
When building a tx plan what should we consider?
slow gradual introduction of dental equipment and procedures in a predetermined planned manner we must incorporate behaviour management into everything we do
63
How do we ensure child has painless tx?
Care takem to avoid hurt to child carry out tx under LA - children feel pain! painless technique to administer LA - such as wand upper carious teeth restored with la before lower
64
What teeth do we restore with LA first?
upper carious teeth before lowers
65
What is the first part of a tx plan when we build ir for kids?
Simple exam OHI Diet F varnish application radiographs explanation of next visit
66
What would happen on second visit (tx plan)?
Brush teeth demo using kids brush diet check radiographs polish and dry teeth introduction of slow speed and air syringe fissure sealant process explained
67
What can we do on the 3rd visit?
Fissure sealants saliva ejector introduction
68
What tx can we do as we progress with tx plan?
Remove carious tissue with hand excavator if immediate temporisation is req use slow speed drill introduce topical give rubber dam home
69
if immediate temporisation is req what do we do?
remove carious tissue with hand excavator
70
As child gets more comfy what can we do?
5. restore upper teeth with la, topical 6. restore lower teeth with la and topical 7, pulp tx, xla

3. Paediatrics (10 decks)

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