Behavior Guidance for Pediatric Patients PDF

14.10.2024 BEHAVIOR GUIDANCE FOR PEDIATRIC PATIENTS ASSOC. PROF. DR. SİNEM Childhood is life's greate...

14.10.2024 BEHAVIOR GUIDANCE FOR PEDIATRIC PATIENTS ASSOC. PROF. DR. SİNEM Childhood is life's greatest BİRANT period of physical, physiological and emotional growth. BEHAVİOUR GUİDANCE BEHAVİOUR GUİDANCE Aim: Dentist Reducing fear and anxiety Ensuring permanent behavior change Receive positive feedback Effective Communication To understand the importance of good oral health Child Parents To provide quality dental service EMOTİONAL DEVELOPMENT STAGES İN BEHAVİOUR GUİDANCE CHİLDREN Sleep Child (0-1 years)  In pedodontics, the patient-dentist relationship has an important role at the beginning of the treatment. The biggest factor on the babys development is SLEEP.  While some of the behavior management techniques provide He shows devotion to his parents. building relationship, some of them provide correction of wrong behaviors. It is the period when the basic sense of trust develops. The first dentition is observed and the first control time comes. 1  14.10.2024 EMOTİONAL DEVELOPMENT STAGES İN EMOTİONAL DEVELOPMENT STAGES İN CHİLDREN CHİLDREN SweetTrouble (2-3 years) The Birth of Logic (3-4 years)  Imagination begins to develop.  He can say his first and last name  He can count 3 things.  The child's self-conscious movements begin.  He can tell his age and gender.  He sees everything from his own perspective.  He enjoys receiving compliments on  He speaks short sentences (me, no, what?). his behavior and clothes.  He shows devotion to his parents.  He has a great need for his mother's presence, is afraid of getting away from  He is afraid of loud noises and strangers. his mother.  He can be annoyed from some noises. EMOTİONAL DEVELOPMENT STAGES İN EMOTİONAL DEVELOPMENT STAGES İN CHİLDREN CHİLDREN Creative & Exaggerating (4-5 years) Creative & Exaggerating (4-5 years)  He is afraid of sound.  Personality and abilities develop.  He understands and responds to verbal requests.  He knows colors  His balance is developed.  He can count 4 things.  He can draw shapes (cross, square etc.).  He can lie.  5 senses perception is very sensitive, he may afraid of reflector light.  He tells exaggerated stories.  His questions during the treatment are aimed at delaying the treatment rather  He can be very aggressive and stubborn. than curiosity. EMOTİONAL DEVELOPMENT STAGES İN EMOTİONAL DEVELOPMENT STAGES İN CHİLDREN CHİLDREN Peak of Egoism (6-7 years) Big Chatter (5-6 years old) He is both an angel and a demon. He likes repetition and simple rules. He knows over 1000 words and tells the meaning of the words. He may give unexpected reactions. He is proud of what he does. He is afraid of harm to his body. He may be separated from her parents during treatment. When the treatment session lasts more than 15-20 minutes, he starts to get boring. He is afraid of harm to his body. He has no trouble getting away from his mother. Since he sees the teacher as a symbol of authority at school, he has no difficulty in accepting the dentist's authority. 2  14.10.2024 EMOTİONAL DEVELOPMENT STAGES İN EMOTİONAL DEVELOPMENT STAGES İN CHİLDREN CHİLDREN School (Calm Down) Period (7-9 years old) Self Motivation Period (9-10 years old) He is a good listener. True-false gain meaning. His skills develops in mathematics and other branches. He is cooperative. He has good cooperation. He gets tired quickly, sessions can last 30-60 minutes. Increased energy and desire to learn is observed. Unexpected reactions are reduced. Social feeling develops. Instead of direct explanation, indirect explanation is very effective. It is the age of balance. EMOTİONAL DEVELOPMENT STAGES İN CHİLDREN PARENT TYPES  2-3 years: Afraid getting away from  Overprotective Family: parents and fear of strangers The child cannot make his own decisions. He is cowardly, It is necessary not to insist on taking the shy and docile. He accepts all requests of the dentist, and it parents out of clinic during the is easy to cooperate with him. examination.  4-6 years: Fear of bodily harm and  Rejecting Family: injury The child is insecure, uncooperative, indifferent to the  7-8 years: Begins to control fears environment and devoid of love.The family is in constant opposition.The child should be given confidence, be  8-14 years: Adapts to the interested, and cooperate with the child. environment, can cooperate with the dentist PARENT TYPES PARENT TYPES Identifying Family: If the child does not do what is asked, the family will be disappointed. As a result of excessive concern and If the child does not want treatment, parents force the doctor. interest towards the child, the child is afraid Extremely and anxious. The inner world of the child becomes anxious and fearful with the Anxious experiences he hears from the environment. Negligent Family: Family: First of all, the family's anxiety should be eliminated. Telling bad experiences and They skip their appointments, concerns to the child should be prevented. They don't come to follow-up appointments. They are very difficult to motivate. Offensive Family: Although the child is afraid of the treatment, They feel extremely anxious and insecure. This distrust may be Dominant he usually accepts it. He is a coooperative patient if treated with kindness. towards the dentist's experience, the health system in general, and Family: With a caring attitude(unlike the family), the external environment. They act aggressively due to lack of children are tried to be won. knowledge. 3  14.10.2024 FAMİLY RELATED PROBLEMS ADVİCE FOR THE PARENTS  Parents should never project their own fears onto the child.  Continuous intervention of the family to the dentist and the child can cause problems.  The dentist should not be used for punishment or intimidation.  The child-dentist relationship can be damaged by the family's requests and questions.  They should bring the child to the dentist at an early age.  The child's attention is divided between the dentist and the family.  Bribery should not be given when bringing the child to the dentist.  The dentist's attention is also distracted between the child and the family. Mutual communication with parents should be developed, and the treatment and  In order to overcome the child's fear, he options to be applied should be discussed should not be mocked. with the family.  It should not be promised that the procedures to be performed by the dentist ADVİCE FOR will not be done beforehand. For positive dental treatment, the child COMMUNİCATİON THE should be given a task (holding saliva WİTH FAMİLY AND  Dentist's treatment should not be CHİLD ejector, opening his mouth, etc.). PARENTS interfered with.  Before going to the dentist, the procedure should be explained to the child. Both the child and the family should feel in security. COMMUNİCATİON WİTH FAMİLY AND FRANKL BEHAVIOR RATING SCALE CHİLD DEFINETELY NEGATIVE (--)  Pediatric dentists spend 60% of their appointment time by talking to the Refusal of treatment, crying forcefully, fearful or any other overt evidence of extreme family and the child. negativism. NEGATIVE (-)  Another topic related to effective communication is “Active Listening”. Reluctant to accept treatment; uncooperative, some evidence of negative attitude but not pronounced, i.e. /sullen, withdrawn.  It has been shown that Active POSITIVE (+) listening minimize misunderstandings between dentist, family and child. Acceptance of treatment; at times cautious, willingness to comply with the dentist, at  The pediatric dentist should be an times with reservation but patient follows the dentist's directions cooperatively. expert in problem solving. DEFINETELY POSITIVE (++) Good rapport with the dentist, interested in the dental procedures, laughing and enjoying the situation. 4  14.10.2024 CHİLD'S BEHAVİOR AND REACTİONS CHİLD'S BEHAVİOR AND REACTİONS What are children They are afraid of the A new environment is afraid of? unknown, frightening for them, The first reaction is “FEAR” They lose their self- They are afraid that confidence in the face of their body will be foreign environments, harmed and they will large places and foreign feel pain, people. CHİLD'S BEHAVİOR AND CHİLD'S BEHAVİOR AND REACTİONS REACTİONS  ANXIETY  There are some definitions that should be known in order to It is an unconscious feeling that can be understand and distinguish behavior controlled by the individual. Its etiology is management problems: complex and multifactorial. It is often directly proportional to previous  Dental fear negative medical experience or traumatic  Dental anxiety dental experience.  Dental phobia CHİLD'S BEHAVİOR AND REACTİONS CHİLD'S BEHAVİOR AND REACTİONS  Objective Fear It is the fear of physical stimuli. It stems from the individual's own experiences.  FEAR  Subjective Fear It is fear that is transmitted indirectly. They are deep and It occurs immediately after birth. recurrent fears. Factors causing subjective fear: It is a primary emotion. It is difficult for a person to control  Experiences heard from friends this emotion.  Parent's fear of dentist  Unknown factors  Fears exaggerating by thinking  Memories and dreams 5  14.10.2024 CHİLD'S BEHAVİOR AND CHİLD'S BEHAVİOR AND REACTİONS REACTİONS Fear Symptoms  Facial redness What Not to Do in Case of Fear  Pale face  Sweating  Not admitting that the child is afraid  Acceleration in breathing  Forcing the child into an environment of fear  Tachycardia  Punishing the child for being afraid  Making fun of the child for being afraid  Insomnia, restlessness and pain that have been going on for a few days in pediatric patients affect the child's behavior in an undesirable way. CHİLD'S BEHAVİOR AND REACTİONS APPEARANCE OF DENTİST  Scrubs of different colors can be PHOBIA worn for children who are afraid of white scrubs.  Protective clothing and tools such as masks, gloves, goggles should be used by explaining the purpose to the patient. It is a severe form of dental anxiety. It is a persistent fear of  Dentist can communicate physically as well as verbally. Eye contact is visible situations/objects. It leads important. to avoidance of dental treatment or to continue treatment in fear. APPEARANCE OF DENTİST  Talking with the WE message is effective.  Some degree of displeasure with the PRACTİCE child's negative  The child likes to be greeted in the environment reactions should be expressed. prepared for him.  Books, toys and pictures can be found in the  The first appointment and treatment should waiting room. be short-term.  Children may be affected by other patients who are waiting and undergoing treatment. 6  14.10.2024 BEHAVIOR GUIDANCE TECHNIQUES CHAT  While talking to the child, daily simple words should be chosen according to the age, and the topics that will attract the child's attention should be mentioned.  Conversation should be calm and confident. 0 Psychosedative Techniques  Words that will trigger the child's fear such as needles and extraction should not be used.  Treatment should be carried out as soon as 0 Pharmacosedative Techniques possible and with the least amount of pain.  The words used should be clear and to the message. Positive actions should be praised. BEHAVIOR GUIDANCE TECHNIQUES PsychosedativeTechniques TELL-SHOW-DO Tell-Show-Do It is the most used method. Ask-Tell-Ask Modelling Hand-over-mouth Every treatment stage is first explained to the child, Positive behaviour guidance shown (demonstrated) and then applied. Distraction Desensitization Voice control Purpose: To inform the child about the treatment to Nonverbal communication be performed and to make the unknown known. Memory restructuring Enhancing control It can be applied to all children. When describing the procedures, terms that the child will like are used. Parental presence / absence Medical immobilization TELL-SHOW-DO Introduced Tool/Process Identification Air spray Wind Saliva ejector Elefant trunk Impression material Play dough Bur Brush, pencil Decay Bacteria Probe Teeth counter, germ detector TELL-SHOW-DO x-ray Photo Aerator Bather Angldruva Shaking, tickling 7  14.10.2024 This technique involves inquiring about the ASK-TELL-ASK patient’s visit and feelings toward or about any planned procedures (ask); Objectives: explaining the procedures through ASK-TELL- demonstrations and non-threatening  assess anxiety that may lead to noncompliant behavior during treatment; ASK language appropriate to the cognitive level of the patient (tell);  teach the patient about the procedures and their implementation; and  confirm the patient is comfortable with the treatment before proceeding. and again inquiring if the patient understands and how she feels about the Indications: Use with any patient able to dialogue. impending treatment (ask). POSİTİVE BEHAVİOR GUİDANCE MODELLİNG METHOD It is the rewarding of the positive progress of the child during the treatment by the dentist.  Purpose: These can be verbal rewards (well done, To try to ensure cooperation bravo, etc.), stickers, certificates or toys in the non-cooperative patient by showing a cooperative Incompatible behavior should not be child of the same gender and supported. age as a model during treatment. This method can be applied to all children. Purpose: To ensure that the right behavior is permanent. HAND-OVER-MOUTH HAND-OVER-MOUTH  It is applied to maladaptive children who cannot be cooperated with classical behavior management methods. This technique is not applied  The doctor covers the child's mouth with his hand to children under the age of This technique has been or a towel and tells his ear that he will raise his hand if he calmly stops crying. 4, children with upper removed from the AAPD respiratory tract problems behavioral management  If the child is silent, he raises his hand and praises and children who cannot guide !!! him, saying that he made the right decision. communicate verbally !!!  The goal is to get the child's attention, to make them calm enough to hear what the dentist is saying. 8  14.10.2024 DİSTRACTİON DESENSITIZATİON  Description: Distraction is the technique of diverting the patient’s attention from what may be perceived  It is a technique used to eliminate fears that cause as an un-pleasant procedure. tension in the child.  Distraction may be achieved by imagination (e.g.,  It includes 3 phases: stories), clinic design, and audio (e.g., music) and/or  Trying and teaching the patient to relax visual (e.g., television, virtual reality eye-glasses) effects.  Blocking the stimulants of basic fear Objectives:  Starting from the minor factor that cause fear to the patient, proceeding in order at each stage and  decrease the perception of unpleasantness; desensitizing the patient  avert negative or avoidance behavior.  The gradual approach is the step-by-step progression of the child's desired behavior. DESENSITIZATİON Child brushes his teeth in the washstand VOİCE CONTROL  Adjusting the loudness, tone, or timbre of the voice to guide and manage the patient's behavior. Mom and dentist brush their teeth  An explanation should be given to the parent to avoid misunderstandings. The child sits in the box, examination and prophylaxis are performed Purposes:  Attracting the patient's attention and ensuring coooperation Normal treatment of the child is performed  Avoid negative behavior  Establishing appropriate adult-child roles, providing authority STEP-BY-STEP THERAPHY NONVERBAL COMMUNİCATİON MEMORY RESTRUCTURİNG  Description: Nonverbal communication is the reinforcement and guidance of behavior through  Memory restructuring is a behavioral appropriate contact, posture, facial expression, and approach in which memories body language. associated with a negative or difficult Objectives: event (e.g., first dental visit, local anesthesia, restorative pro-cedure,  enhance the effectiveness of other communicative extraction) are restructured into guidance technique positive memories using information  gain or maintain the patient’s attention and suggested after the event has taken compliance. place. 9  14.10.2024 MEMORY RESTRUCTURİNG MEMORY RESTRUCTURİNG A visual reminder could be a photograph of the child smiling at the initial visit (i.e., prior to the difficult experience). Restructuring involves four components: Positive reinforcement through verbalization could be asking if the child had  (1) visual reminders; told her parent what a good job she had done at the last appointment. The child is asked to role-play and to tell the dentist what she had told the parent.  (2) positive reinforcement through verbalization;  (3) concrete examples to encode sensory details; Concrete examples to encoding sensory details include praising the child for and specific positive behavior such as keeping her hands on her lap or opening her mouth wide when asked.  (4) sense of accomplishment The child then is asked to demonstrate these behaviors, which leads to a sense of accomplishment. PARENTAL PRESENCE/ABSENCE Objectives:  restructure difficult or negative past dental experiences; and The presence or absence of the parent some-times can be used to  improve patient behaviors at subsequent gain cooperation for treatment. MEMORY dental visits. RESTRUCTURİNG Indications: Use with patients who had a negative or difficult dental visits. Parents’ desire to be present during their child’s treatment does not mean they intellectually distrust the dentist; it might mean they are uncomfortable if they visually cannot verify their child’s safety. PARENTAL PRESENCE/ABSENCE PARENTAL PRESENCE/ABSENCE The objectives of parental presence/absence for parents are to: It is important to understand the changing emotional  participate in examinations and treatment; needs of parents because of the growth of a latent but  offer physical and psychological support; and natural sense to be protective of their children.  observe the reality of their child’s treatment. The objectives of parental presence/absence for practitioners to:  gain the patient’s attention and improve compliance; Practitioners should become accustomed to this added  avert negative or avoidance behaviors; involvement of parents and welcome the questions and  establish appropriate dentist-child roles; concerns for their children.  enhance effective communication among the dentist, child, and parent;  minimize anxiety and achieve a positive dental experience; and  facilitate rapid informed consent for changes in treatment or behavior guidance. 10  14.10.2024 MEDİCAL IMMOBİLİZATİON MEDİCAL IMMOBİLİZATİON  Papoose board or pediwrap is used for medical immobilization.  Sometimes partial or complete immobilization of the patient is required for treatment.  Before the procedure, parents should be informed and consent should be obtained. Papoose Board MEDİCAL IMMOBİLİZATİON MEDİCAL IMMOBİLİZATİON Mouth prob Pediwrap Finger guard BEHAVIOR MANAGEMENT MEDİCAL IMMOBİLİZATİON RECOMMENDATIONS Indication: 1. The cause of dental fear should be investigated by making a child- For emergency examination and treatment in non-cooperative, resistant child specific treatment plan. For emergency examination and treatment of mentally/physically disabled children 2. The characteristics of the child should be known (age, character, In children who cannot cooperate with other behavior management techniques development, etc.) In situations where the patient or dentist may be at risk when immobilization is not used. 3. Effective communication should be established between child and Contraindication: dentist Cooperative children Children who cannot be safely immobilized due to their medical condition 11  14.10.2024 BEHAVIOR MANAGEMENT BEHAVIOR MANAGEMENT RECOMMENDATIONS RECOMMENDATIONS 4. It is necessary to have sufficient knowledge and equipment on behavior management and techniques 7. While making the treatment plan, the first appointment must be in the form of a control (except for emergencies) 5. Consultation with a child psychologist should be considered in overreactions and complicated situations caused by fear. 8. Empathy should be done by considering the needs of the patient. 6. The duration of treatment should neither be too long nor too fast. 9. Consensus should be established between the family, the child and the dentist and they should work together THANK YOU… 12