child behavior management techniques

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  • Child behavior

  • Are we managing our childrens behavior or just treating dental caries ?

  • Behaviour: Is an observable act, which can be described in similar ways by more than one person.

    It is defined as any change observed in the functioning of the organism.

    Behavioural pedodontics:- It is a study of science which helps to understand development of fear, anxiety and anger as it applies to child in the dental situations

  • Normal behaviour :-

  • Emotion is a state of mental excitement characterized by physiological, behavioral changes and alterations of feelings.

  • Commonly seen emotions in a child

  • Cry (Elsbach 1963)

    Obstinate cry,Frightened cry ,Hurt cry, Compensatory cry

  • Anger

  • FearIt may be defined as an unpleasant emotion or effect consisting of psycho-physiological changes in response to realistic threat or danger to one's own experience.

    Innate fear Subjective fear Objective fear:

  • Fear Evoking Dental Stimuli

    Factors Causing Dental Fear1. Fear of pain or its anticipation.2. A lack of trust or fear of betrayal.3. Fear of.1oss of control.4. Fear of the unknown.5. Fear of intrusion.

    SIGNS AND SYMPTOMS OF FEAR

  • Anxiety

    Is an emotion similar to fear arising without any objective source of danger. Is a reaction to unknown danger.It is often been defined as a state of unpleasant feeling combined with an associated feeling of impending doom or danger from within rather than from without. It is a learned process being in response to one's environment. As anxiety depends on the ability to imagine, it develops later than fear.

  • Types of anxiety

    Trait anxietytemperament feature. These children are generally jittery, hypersensitive to stimuli.

    Free floating anxiety- persistently anxious mood

    Situational anxiety- Seen only to specific situations or objects.

    State anxiety-

    General anxiety -a chronic pervasive feeling of anxiousness whatever the external circumstances.

  • Anxiety Scale

  • Phobia:Defined as persistent, excessive, unreasonable fear of a specific object, activity or situation that results in a compelling desire to avoid the dreaded object.

    SimpleSituationalSocial

  • Behavior management

  • Behavior management

  • Behavior managementBehavior management is the means by which the dental health team effectively and efficiently performs treatment for a child and, at the same time, instills a positive dental attitude.The fundamentals of behavior management center on the attitude and integrity of the entire dental team.

  • FUNDAMENTALS OF BEHAVIOR MANAGEMENTPositive approach- Positive statementsTeam attitude- Friendly and caringOrganization- Well organized dental team and treatment Truthfulness- Black or White ,nothing grayTolerance- Ability to rationally cope with the misbehaviors Flexibility-as situation demands

  • CLASSIFYING CHILDREN'S BEHAVIOR

    Wright's clinical classification (1975)

    Cooperative Lacking in cooperative ability Potentially cooperative.

  • Potentially cooperative

    Uncontrolled/Hysterical, Defiant/obstinate, Tense-cooperative, Timid/shy, Whining, and Stoic behavior

  • Frankels Behavioral Rating Scale. (1962) Rating 1: Definitely Negative. Refusal of treatment, forceful crying, fearfulness, or any other overt evidence of extreme negativism. Rating 2: Negative. Reluctance to accept treatment, uncooperativeness, some evidence of negative attitude but not pronounced.Rating 3: Positive. Acceptance of treatment; cautious behavior at times; willingness to comply with the dentist, at times with reservation, but patient follows the dentist's directions cooperatively.Rating 4: Definitely Positive. Good rapport with the dentist, interest in the dental procedures, laughter and enjoyment.

  • Wilson's classification (1933)

    a) Normal or bold: The child is brave enough to face new situations, is co-operative, and friendly with the dentist. b) Tasteful or timid: The child is shy, but does not . interfere with the dental procedures. c) Hysterical or rebellious: Child.is influenced by home environment - throws temper-tantrums and is rebellious. d) Nervous or fearful: The child is tense and anxious, fears dentistry.

  • Lampshire Classification (1970)1. Co-operative: The child is physically and emotionally relaxed. Is cooprative throughout the entire procedure2. Tense cooperative: The child is tensed, and cooperative at the same time.3. Outwardly apprehensive: Avoids treatment initially, . usually hides behind the mother, avoids looking or talking to the dentist. Eventually accepts dental treatment.4. Fearful: Requires considerable support so as to overcome the fears of dental treatment.5. Stubborn/Defiant: Passively resists treatment by using techniques that have been successful in other situations.6. Hypermotive: The child is acutely agitated and resorts to screaming kicking etc.7. Handicapped: Physically/mentally, emotionally handicapped.8. Emotionally immature

  • Factors affecting Childs behavior Under the control of dentistUnder the control of parents

    Maternal anxiety and attitudes [Overprotective, Overindulgent, Under affectionate, Rejecting, authoritarian]Others [socioeconomic status, nutritional,past dental experience]

  • Behavior Management techniques can be broadly classified as:Non-Pharmacological Techniques.

    Pharmacological Techniques

  • Non-pharmacological methods1. Communication2. Behavior shaping (modification)a. desensitizationb. modellingc. contengency management3. Behavior managementa. audioanalgesiab. biofeedbackc. voice controld. hypnosise. humorf. copingg. relaxationh. implosion therapyi. Aversive conditioning

  • Communication

  • CommunicationVerbal [establishment of communication,

    establishment of communicator ,message clarity,tone]

    Nonverbal [Multi sensory Communication]

    Problem Ownership Use I messages,

    Active Listening

    Appropriate Responses to the situation

  • DENTAL TERMINOLOGY WORD SUBSTITUTES

    rubber dam rubber raincoat rubber dam clamp tooth button rubber dam frame coat rack sealant tooth paint topical fluoride gel cavity fighter air syringe wind gunwater syringe water gun suction vacuum cleanerAlginate puddingstudy models statueshigh speed whistlelow speed motorcycle

  • Behavior shapingBy definition, it is that procedure which very slowly develops behavior by reinforcing successive approximations of the desired behavior until the desired behavior comes to be.

    : Stimulus response (S-R) theory

  • Systematic Desensitization ..exposure to hierarchy of fear producing stimuli Desensitization : (joseph Wolpe)

  • Systematic Desensitization ..exposure to hierarchy of fear producing stimuli

  • Tell-show-do[ Addelston]The technique involves verbal explanations of procedures in phrases appropriate to the developmental level of the patient (tell);

    demonstrations for the patient of the visual, auditory, olfactory, and tactile aspects of the procedure in a carefully defined, non threatening setting (show);

    and then, without deviating from the explanation and demonstration, completion of the procedure (do).

    The tell-show-do technique is used with communication skills (verbal and nonverbal) and positive reinforcement.

  • Tell-show-do Objectives:1. teach the patient important aspects of the dental visit and familiarize the patient with the dental setting;

    2. shape the patients response to procedures through desensitization and well-described expectations.

  • Acclimatisationgetting familiarized

  • Modelling Bandura (1969)

    LiveFilmed Posters Audiovisuals

  • Modeling

    Allowing the patient to observe one or more individuals [models]Patient frequently imitates the models

  • Contingency managementPositive reinforcerNegative reinforcers

    SocialMaterialActivity

  • Positive reinforcement

    to give appropriate feedback. to reward desired behaviors and thus strengthen the recurrence of those behaviors.Social reinforcers include positive voice modulation,facial expression, verbal praise, and appropriate physical demonstrations of affection by all members of the dental team Nonsocial reinforcers include tokens and toys.

    Objective: Reinforce desired behavior..

  • 3. Behavior managementa. audioanalgesia: white noiseb. biofeedback: detect physiological processesc. voice controld. hypnosis: altered state of consciousness e. humor:f. coping: signal systemg. relaxation:h. implosion therapyi. Aversive conditioning

  • Enhancing control..STOP SIGNAL

  • Voice Control Voice control is a controlled alteration of voice volume, tone, or pace to influence and direct the patients behavior.

    Objectives:1. gain the patients attention and compliance;2. avert negative or avoidance behavior;3. establish appropriate adult-child roles.

  • RetrainingTo review and retrain the response to a given set of stimuli

  • Distraction

    Diverting the patients attention from what may be perceived as an unpleasant procedure.

    MusicVideoTalkingWhite noise.HypnosisBreathing

  • DistractionObjectives:1. decrease the percep

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