behavior management techniques for the pediatric dental patient

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  • 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 2000s

    Fewer children living in traditional family setting

    Women: bearing less children and later in lifeThose 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 2000s

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

    changingWomen 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 ManagementVoice ControlNonverbal communicationTell-Show-DoPositive ReinforcementDistractionParental Presence/Absence

  • Voice Control

    Controlled alteration of voice volume, tone or pace to influence and direct the patients behavior

  • Voice Control

    Note the proximity of the dentist to the patient

  • Voice Control

    To gain the patients attention and complianceTo avert negative or avoidance behaviorTo 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 patients 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 childs 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 patients 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 patients 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 treatmentWide 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 Childrens 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 patients 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 conversationMay 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 childs questions Acknowledge by repeating them backAlso need to establish authority

  • Effective Dentists

    Establish rules for patients to followTeach their patientsDemonstrate kindness

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