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3. Paediatrics > Behavioural Management Techniques in Paeds > Flashcards

Behavioural Management Techniques in Paeds Flashcards

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
Q

How do we calm DFA?

A

Give control back to pt

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26
Q

How do we give control back to pt?

A

Stop signals

rest breaks

answer any qs pt has

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27
Q

How do we establish if a pt has dental fear?

A

Ask about previous dental tx, experience they had, how they feel about dentistry now

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28
Q

What is the MCDAS?

A

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)

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29
Q

What are the advantages of MCDAS?

A

Quick
Easy to use
allows pts to rate diff aspects of dental tx
we can establish base line levels of anxiety

30
Q

What does good dentist/pt communicate allow for?

A

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
Q

What are the 3 components of communication?

A

verbal
paralinguistic
non verbal

32
Q

What is the role of the dentist/pt?

A

reduce pt anxiety

  • prevent pain
  • establish trust
  • work quickly
  • be calm
  • provide moral support
  • reassure about pain
  • emapthetic
33
Q

When putting topical LA what can we say to pt to address the way they may feel?

A

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
Q

What will increase fear related behaviours?

A

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
Q

What is the problem with children and pain?

A

They may not be able to communicate with us that they feel pain - we must monitor expressions for this

36
Q

What will pain expressions look like?

A

Screwing up eyes

lowering brows

mouth in square appearance

37
Q

What does expression of fear look like?

A

Eyes wide open

raised brows

mouth open

tense

38
Q

What is MTD?

A

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
Q

Is a Childs behaviour affected by parental presence or absence?

A

No - no evidence to suggest this

40
Q

When would Childs behaviour be better with parental present?

A

4 OR UNDER

41
Q

Why is parental presence important?

A

So they can see pt misbehave and not comply with tx - will understand when we refer

42
Q

Why is the parent useful at dental appointments?

A

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
Q

What is a knee to knee exam?

A

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
Q

What are some BMTs?

8

A

Positive reinfircement

tell show do

acclimatisation

desensitisation

voice control

distraction

role modelling

relaxation/hypnosis

45
Q

What is positive reinforcement?

A

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
Q

What can we use for pos reinforcement?

A

Facial expression - smile

Verbal praise - well done

47
Q

What is important about verbal reinforcement?

A

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
Q

What are some non social reinforcers?

A

Stickers

colouring posters

clever certificates

49
Q

When may we tell a child they are clever v giving clever certificate?

A

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
Q

What is the tell show do technique used for?

A

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
Q

What is acclimitisation?

A

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
Q

How do we acclimatise for fissure sealant placement?

A

Introduce 3 in 1 - hairdryer

introduce suction

introduce cotton wools

53
Q

How should we acclimatise LA?

A

Introduce topical one visit before LA

54
Q

What is systematic desensitisation?

A

This is based on assumption that repeated non distressing exposure to anxiety provoking stimulus will eventually reduce anxiety

55
Q

How do we do systematic desensitisation?

A

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
Q

What is voice control?

A

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
Q

What is distraction?

A

This is where the divert pts attention from what may be an unpleasant procedure

58
Q

What are some distraction techniques?

A

pulling upper lip

telling story whilst giving LA

music

you will fell im holding ur lip (inject la as you say this)

59
Q

What is role modelling?

A

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
Q

What are two relaxation techniques?

A

Progressive muscle relaxation

Space exercise - in for 3 out for 5

61
Q

What is hypnosis?

A

This is where we try influence subjects perception, feelings, thinking and behaviour by asking them to concentrate on ideas and images

62
Q

When building a tx plan what should we consider?

A

slow gradual introduction of dental equipment and procedures in a predetermined planned manner

we must incorporate behaviour management into everything we do

63
Q

How do we ensure child has painless tx?

A

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
Q

What teeth do we restore with LA first?

A

upper carious teeth before lowers

65
Q

What is the first part of a tx plan when we build ir for kids?

A

Simple exam

OHI

Diet

F varnish application

radiographs

explanation of next visit

66
Q

What would happen on second visit (tx plan)?

A

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
Q

What can we do on the 3rd visit?

A

Fissure sealants

saliva ejector introduction

68
Q

What tx can we do as we progress with tx plan?

A

Remove carious tissue with hand excavator if immediate temporisation is req

use slow speed drill

introduce topical

give rubber dam home

69
Q

if immediate temporisation is req what do we do?

A

remove carious tissue with hand excavator

70
Q

As child gets more comfy what can we do?

A
  1. restore upper teeth with la, topical
  2. restore lower teeth with la and topical

7, pulp tx, xla

3. Paediatrics (10 decks)

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