behavior management techniques for the pediatric dental patient

Behavioral Management Techniques for the

Pediatric Dental PatientJacey Sheckler, RDH, MS

Fall 2017

Behavior Management

Behavior Management

•Goals of communication and education

• Process of dialogue, facial expression, and voice tone

•Build a relationship between dentist and patient

To maintain compliance

• Skills of verbal guidance

• Expectation setting

• Extinction of inappropriate behavior

• Reinforcement of appropriate behavior

Objectives

•To effectively and efficiently perform treatment for the child

•To instill a positive attitude

Behavior in the 2000’s

•Fewer children living in traditional family setting

•Women: bearing less children and later in life

•Those living in family households: now less stable, more heterogeneous

Pediatric Dental Triangle

• Patient should always be your highest concern

• Continuum of interactions between all three persons

Child

Parent Dentist

Behavior in the 2000’s

• > 50% of all children likely to experience living with a single parent

•More organized facilities here to meet needs of employed parents

Practice Parameters

•General dentists must follow same guidelines as pediatric dentists

• If you do not have many patients who require premed, cannot justify purchase of pulse oximeters, precordial stethoscope, etc.

Practice Parameters

•Recent AAPD Work Force statistic: 80% of dental procedures performed on children are done by general dentists

•Good reason to become more adept with behavior management skills

Dental Profession• Professional profile is

changing

•Women have entered profession in significant numbers and may have a different behavior management style

• Insurance companies may not approve conscious or IV sedations

Dental Profession

• Society is more litigious

• Parents are not consenting to physical and mechanical restraints

• Dentist may be portrayed as the abuser

Physical Restraint

• An example of protective stabilization

• Will be discussed in depth at a future lecture

Now is the time to reacquaint ourselves to behavior

management skills

Communicative Management

• Used with both the cooperative and uncooperative child

• Basis for establishing a relationship with the child to allow successful completion of dental procedures

• Helps child to develop a positive attitude toward dentistry

Cooperative vs. Uncooperative

Communicative Management•Voice Control

•Nonverbal communication

•Tell-Show-Do

•Positive Reinforcement

•Distraction

•Parental Presence/Absence

Voice Control

•Controlled alteration of voice volume, tone or pace to influence and direct the patient’s behavior

Voice Control

•Note the proximity of the dentist to the patient

Voice Control

•To gain the patient’s attention and compliance

•To avert negative or avoidance behavior

•To establish appropriate adult-child roles

Nonverbal Communication

•The reinforcement and guidance of behavior through appropriate contact, posture, and facial expression

Nonverbal Communication

•To enhance the effectiveness of other communicative management techniques

•To gain or maintain the patient’s attention and compliance

Tell-Show-Do

•Tell: involves verbal explanations of procedure in phrases appropriate to the developmental level of the child

Tell-Show-Do

• Show: Demonstrations for the patient of the visual, auditory, olfactory, and tactile aspects of the procedure in a carefully defined, non-threatening setting

Tell-Show-Do

• “Showing” the procedure on the child’s baby doll

Tell-Show-Do

•Do: Then, without deviating from the explanation and demonstration, completion of the procedure

Tell-Show-Do

•To teach the patient important aspects of the dental visit

•To shape the patient’s response to procedures through desensitization and well described expectations

Positive Reinforcement

• To establish desirable patient behavior it is essential to give appropriate feedback

• Effective method to strengthen the occurrence of desirable behavior

Positive Reinforcement

• Social reinforces include:

• Verbal praise

• Voice modulation

• Facial expression

• Appropriate physical demonstration of affection

Positive Reinforcement

• Non-social reinforces include:

• Tokens such as stickers

• Small toys

Positive Reinforcement

•The primary goal is to reinforce desired behavior

Distraction

• Technique of diverting the patient’s attention from what may be perceived as an unpleasant procedure

• Used to increase attention span

• Giving a child a hand mirror to hold while a dental procedure is being done

Distraction

Sunglasses to block out the intensity of the light as well as being protective

Distraction

• To decrease the perception of unpleasantness

• To avert negative or avoidance behavior

Parental Presence/Absence

• Technique involves using the presence or absence of parent to gain cooperation for treatment

•Wide diversity exists in practitioner philosophy and parental attitude regarding parents’ presence or absence

Parental Presence/Absence

Would you want this parent watching over you while you treated his son?????

Parental Presence/Absence

• Communication between dentist and child is paramount

• Communication demands focus on the part of both parties

• Children’s responses to parents’ presence may be beneficial or detrimental

Pediatric Dental Triangle

Child

Parent Dentist

Presence could be beneficial or detrimental

Language may be a barrier to communication with the dentist so parental presence is needed.

Parental Presence/Absence

Parental Presence/Absence

“I told him you were an ice cream vendor. You take it from there.”

Parental Presence/Absence

• Each dentist needs to determine the communication methods that best optimize the treatment setting

• Recognize his/her own skills

• Recognize the abilities of the child

• Desires of the specific parent involved

Parental Presence/Absence

• Gain the patient’s attention and compliance

• Avert negative or avoidance behaviors

• Establish appropriate child-adult roles

Parental Presence/Absence

• One of the most controversial issues in pediatric dentistry

• Generally speaking, pediatric dentists keep them out

• Generally speaking, pediatricians keep them in

Parental Presence/Absence

• For parental absence:

• Tend to repeat requests

• Become upset if child misbehaves

• Attempt to draw you in conversation

•May “test” you

Parental Presence/Absence

• Recent studies:

• Kamp (1992) 66% of parents wanted to stay with child

• Certo and Bernat (1992) 75% desired to accompany child

• Bouchner et al (1989) 78% wanted to be with child while IV placed

Parental Presence/Absence

• For presence:

• Can become a “silent” helper

• Good educational tool

Parental Presence/Absence

• Let the parent know:

• The child is the focus of your attention

• Questions will be answered either pre- or post-treatment

Establishing Communication and Authority

•Your main goal should be to prevent uncooperative behavior

•Need to listen to child’s questions

•Acknowledge by repeating them back

•Also need to establish authority

Effective Dentists

•Establish rules for patients to follow

•Teach their patients

•Demonstrate kindness