Pediatric Quiz 1

Who do you get informed consent from

Legal guardian

What is informed consent?

The process of providing the patient, in the case of a minor or incompetent adult, the custodial parent or legal guardian, with relevant information regarding diagnosis and treatment needs. ALLOWS EDUCATED DECISION.

Who requires informed consent

Children under 18 and Diminished capacity.

Why is informed consent varied

Statutes, court decisions, regulations. Each state varies(check where you work!)

When is parental care not necessary

Exceptions based on the specific type of medical care or services provided to the minor. (emergencies)

What is an emancipated Minor

Living separate apart or separate from guardianship, who is managing their own financial affairs. Not considered an adult. Ex. married, military, pregnant

What is an emancipated minor in mn

Court-declared designation. Parents give up the rights and responsibilities

What is a mature minor doctrine

Legal framework that is only in a few states. Minors remain under parental control generally, except for specific medical decisions. Minor is able to consent to specific medical care. Determination is based on the minor's maturity or specific circumstances.

What are the categories of care exemptions

Emergency care, but make an effort to contact parents. Other exemptions: contraceptive, pregnancy related, mental health, drug and alcohol abuse.

What is crucial for the treating practitioner

Must disclose the information that he/she considers important to the patient's decision making process.

Q/A: The adult accompanying the pediatric patient may not be a legal guardian allowed by law to consent to medical procedures. What do you do

Reappoint, call the legal guardian.

What is required for the initial appointment

Legal guardian there to establish care.

What is an option for a parent that is not available in the future

Legal guardians may complete authorization to discuss protected information for future visits.

What is required for restorative care

Treatment plan must be discussed/reviewed with a legal guardian in the patient's axiUm chart.

What is the SOD Policy

No parent/Legal Guardian Present, need them there for a treatment plan or available. Emergency exception. All efforts to contact patients must be in the patient chart.

What is the emergency exception

Treatment may be provided without consent if delaying is detrimental to health.

What is the legal liability of patient care

A medical practitioner may be legally liable if a patient does not give informed consent to a medical procedure that results in harm to the patient.

What are consent forms

Streamline process, standardized information for consistency, allows parents/guardians to read and digest info.

What are components of consent forms

Patient info, treatment details, legal guardian identifier, verification & signatures.

What are special considerations of consent forms

Emergency treatment, extractions, SDF, Nitrous oxide.

Case: 17 y/o male presents to your office. He has pain and swelling, but you cannot get a hold of his parents. Can you see this patient?

The swelling puts this in an emergency. Document all options exhausted to contact the parents. Treat the patient.

What is the AAP consent for Emergency Medical Services policy?

Medical care necessary and likely to prevent imminent and significant harm to a pediatric patient with an emergency medical condition should not be withheld or delayed when problem with consent.

Understand the components of effectively communicating with the parent and child

Verbal messages (the words we choose), paraverbal messages (how we say the words), and nonverbal messages (body language).

What are verbal messages

The words we choose; should be brief, succinct, organized, free of jargon, and minimize resistance.

What are paraverbal messages

How we say the words through emphasis, pitch, pacing, and tone of voice.

What are nonverbal messages

Body language including facial expressions, posture, and gestures.

How much of communication is based on body language

55%.

What are key communication points to discuss with parents

Bacterial transmission, first dental visit by age one, impact of baby teeth on permanent teeth, brushing supervision until age 8, and fluoride preventing/reversing early decay.

Why is health literacy important in pediatric dentistry

Limited health literacy skills significantly impact children's health status and outcomes.

Why is eye-level connection important when talking to children

It helps build trust and communication with the child.

How should language be adapted when speaking to children

Based on the child's age and communication skills.

What is important when communicating with children

Confidence is key.

What parental factor is strongly linked to a child's dental anxiety

Parental anxiety.

What are the four parental styles

Authoritative, authoritarian, permissive, and uninvolved.

Why are past experiences important in behavior guidance

Previous medical or dental experiences can affect a child's response to treatment.

Why should parents be educated about early dental visits

To increase awareness of dental problems before they exist.

What is fear

An unpleasant emotion with psycho-physiological changes in response to a realistic threat or danger.

What is anxiety

An unpleasant emotion with psycho-physiological changes without a realistic threat.

What is the purpose of the Frankl Behavioral Rating Scale

To classify behavior at dental visits and provide information for future providers.

What is a Frankl rating of 1 or --

Definitely negative behavior with refusal of treatment, forceful crying, fearfulness, or extreme negativism.

What is a Frankl rating of 2 or -

Negative behavior with reluctance, uncooperativeness, or mild negative attitude.

What is a Frankl rating of 3 or +

Positive behavior with acceptance of treatment and cooperative behavior.

What is a Frankl rating of 4 or ++

Definitely positive behavior with good rapport, interest, laughter, and enjoyment.

What are examples of pre-appointment behavior modification

Virtual tours, recommended media, and live modeling.

What are the principles of communication guidance

Be positive, build rapport, avoid negatives, and be truthful.

What is direct observation

Observing a sibling or parent perform or experience something first.

What is Tell-Show-Do

Explain the procedure, demonstrate it, then perform it.

Is Tell-Show-Do meant to educate children on oral health

No.

What is Ask-Tell-Ask

Ask about concerns, explain the procedure, then ask about remaining questions.

What is voice control

Using vocal modulation, reinforcement, and parental notes to guide behavior.

What is non-verbal communication in behavior guidance

Using positive or negative body language cues.

What is positive reinforcement

Providing praise and appropriate feedback.

What is distraction in pediatric dentistry

Diverting attention away from the procedure.

When is parental presence/absence most useful

For children under 4 years old.

What should NOT be done in advanced behavior guidance

Ignoring fear, forcing contact, shaming, bribing, threatening, dishonesty, and parental promises.

What SHOULD be done in advanced behavior guidance

Take the attitude of a teacher and be empathetic.

Why are positive dental visits important for young children

They help establish rapport and create positive dental experiences.

What age group benefits most from a happy visit

Children ages 1-4 years.

How can providers create a positive dental visit

Give compliments, let children pick a toothbrush, take it slow, and show them the setup.

What are the components of effectively communicating with the parent and child

Verbal messages, paraverbal messages, and nonverbal communication.

What are Verbal messages

the words we chose

What is effective verbal messaging

Brief, succinct, & organized, Free of jargon, Minimize resistance

What is Paraverbal messages

(how we say the words)

What is effective paraverbal messages

Emphasis in sentence structure, varies in pitch, pacing and tone of voice.

What is Nonverbal messages

our body language

What is effective nonverbal messages

55% of what we say is based on our body language. Physical expression is covered through facial expressions, postures, and gestures.

What are the Highlighted issues that we need to communicate to parents

bacterial transmission, first dental visit, age one, impact of baby teeth on permanent ones, brushing supervision by age 8, fluoride prevents & reverses early decay.

How does limited health literacy effect the child

significantly impacts children's health status and outcomes.

How do you effectively talk to children

Identify words that work, Eye level connection, Language adaptation based on the age and communication skills of the child.

What is key for care

Confidence is key.

What is the importance of guiding dental treatment

helps with behavior modifications during the appointment and anxiety.

What is Parental anxiety

significant correlation between a parent & a child's anxiety.

What are the Parental styles

Authoratative, Authoritarian, Permissive, Uninvolved

What do you do to evaluate Past experiences

have they been to a medical appointment, were they seen, were they put to sleep

How do you help with Awareness of dental problems

educate parents on the value of early dental visits, before dental problems exist.

What is Fear

unpleasant emotion consisting of psycho-physiological changes in response to realistic threat or danger. (anticipation, loss of control, unknown)

What is Anxiety

unpleasant motion consisting of psycho-physiological changes without realistic threat.

What do you do by the first dental visit

Classify behavior, rating is given after each dental appointment. Gives information to other providers to prepare for them.

What is 1 & -- on the Frankl Behavioral Rating Scale

Definitely negative. Refusal of treatment, forceful crying, fearfulness, or any other overt evidence of extreme negativism.

What is 2 & - on the Frankl Behavioral Rating Scale

Negative. Reluctance to accept treatment, uncooperative, some evidence of negative attitude but not pronounced (sullen, withdrawn).

What is 3 & + on the Frankl Behavioral Rating Scale

Acceptance of treatment; cautious behavior at times; willingness to comply with the dentist, at times with reservation, but the patient follows the dentist's directions cooperatively.

What is 4 & ++ on the Frankl Behavioral Rating Scale

Definitely positive. Good rapport with the dentist, interest in the dental procedures, laughter and enjoyment.

What is Pre-appointment behavior modification

virtual tour, recommended media, live modeling.

What is Communication Guidance

Be positive, build rapport, avoid negatives, be truthful!

What is Direct observation

observing a sibling or a parent or how to do something.

What is Tell-Show-Do

Not a way to educate a child on oral health! Explain the procedure, demonstrate how it will be done, and perform the actual procedure.

What is Ask-Tell-Ask

about any concerns, teach about the procedure, about any remaining questions.

What is Voice Control

vocal modulation, reinforcement, and parental notes.

What is Non-verbal Communication

there are both positive and negative forms.

What is Positive Reinforcement

give appropriate praise and feedback.

What is Distraction

diversion of attention away from what is happening.

What is Parental Presence/Absence

best for children under 4 y/o otherwise, not necessary.

What not to do

Ignoring the child's fear, forcing contact, shaming, bribing, threatening, dishonestly, parental promise.

What to do

Take the attitude of the teacher and be empathetic.

What do you want to have established by the end of the appointment

establish rapport, get to know the patient, kids love compliments, let them pick out a new toothbrush, take it slow, show them your set up.