behavior management techniques for the pediatric dental patient
TRANSCRIPT
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