Behavior Guidance

basic behavior guidance- communication and communicative guidance

-appropriate use of commands

-cooperative and uncooperative

-establishes relationship with the child

-allows for successful completion

-supports positive attitude towards health

classifying children’s behavior- Frankl behavioral rating scale

-F4: definitely positive- good rapport, laughter, enjoyment

-F3: positive- acceptance of treatment, cautious behavior, willingness to comply with reservation

-F2: negative- reluctance to accept treatments, uncooperativeness, evidence of negative attitude

-F1: definitely negative- refusal of treatment, forceful crying, fearfulness

-describe objective behaviors in documentation

-”pre-cooperative” if very young and cooperates well

predictors of behavior

-developmental level

-dental attitude

-temperament- can guide behavior

-parental influences- other familial influences

-can assist in anticipating the child’s reaction to care

Piaget’s stages of cognitive development

-schema: a cohesive, repeatable action sequence possessing component actions that are tightly interconnected and governed by a core meaning

-building blocks of behavior, organized knowledge

-as the child develops, the schemata become more complex

Piage’s stages of cognitive development over time

dental attitude

-past experiences

-familial experiences

-previous exposure: positive- video/cartoon (first dental visit), website; negative- anecdotes, negative imagery

parental influence

-positive attitudes toward oral health care may lead to the early establishment of a dental home

-previous experience can inform the parent’s anxiety- children pick up on parental anxiety

-parenting style can influence a child’s ability to cope with a new or challenging circumstance

-frequently, parental expectations for the child’s response to care (no tears, no crying) are unrealistic- expectations for the dentist guiding the child are great

-may want parent to stand where child cannot see them, but still in the room

pediatric dentistry and parents- positives and negatives

-positives: 2-for-1, can improve dental IQ, can help parents with their homecare, teaching opportunity, can reach other children in family (prevent same outcomes)

-negative: helicopter parents, Wiki-parents, jargon (i.e. oil pulling), parental experience (parents feelings influence behavior)

parenting styles

-health history asks how child is guided at home

-determining style may help with ability to communicate well with parents and children

authoritarian parenting style- characteristics and outcomes

-characteristics: demanding/scheduled, high expectations, not responsive, “snowplow parenting” (removing all obstacles), rules and punishment, reserved warmth

-may lead to: low self-esteem, fearfulness, shyness, may misbehave when parent is absent, obedience = love

authoritative parenting style

-characteristics: high expectations, understanding/support, limits and controls, willing to listen and evolve

-may lead to: child understanding opinions are valued, autonomy, engaging in discussion/negotiations

permissive parenting style

-characteristics: aka “indulgent”, not demanding, lenient, avoid confrontation, nurturing and loving, inconsistent rules, lack of structure

-may lead to: lack of self-discipline, egotistic tendencies, insecurity, lack of motivation, clashing with authority

uninvolved parenting style

-characteristics: no knowledge of child’s life, not present, no requirements, not warm

-may lead to: lack of trust, harder to form relationships with others, low self-esteem, lack of self control

snowplow/helicopter parents

-snowplow: allows/encourages child to have new experiences, removes all obstacles, does not want child to experience discomfort

-helicopter: hover nearby, demonstrate protectiveness, watch over every activity

gentle parenting

-effort to turn away from authoritative style (“mindful”, “intentional”)

-affirms emotions and reactions of child are real and important- validates feelings and reactions

-works against orders

-trend on the rise

-trend away from: positive reinforcers, negative reinforcers

dental fear

-not all children demonstrate identifiable “fear behavior”

-much anxiety wanes as individual matures

-positive early experiences can diminish fear

-fear may stem from perception of appointment

-predictor of disruptive behavior- fear incongruent with circumstance

basic management techniques

-TSD: tell show do

-distraction

-non-verbal communication

-positive reinforcement/descriptive praise

-memory restructuring

-enhancing control

-voice control- falling out of favor, try just lowering volume of voice

-parental presence/abseence

-nitrous oxide (permit necessary in some states)

nitrous oxide

-quick and safe

-child does not necessarily sleep- may fall asleep (not always good)

-relieves anxiety

-STILL NEED TO USE BEHAVIOR GUIDANCE

advanced techniques

-protective stabilization

-”hold and go”

-brevity

-”papoose” board

advanced techniques- protective stabilization

-course

-new consent (separate from other consents), signed and dated by parent

-up to date

-periodicity varies by state

-document, have parents help you put child in papoose

advanced techniques- sedation

-minimal, moderate, deep

-enteral sedation (conscious, oral)

-parenteral sedation (IV)

-permits necessary

-advanced training- residency, sedation courses in some states

-many states are adjusting requirements

advanced techniques- general anesthesia

-hospital OR setting

-ambulatory surgery centers

-private practice- dental/physician anesthetist

-hospital privileges

-pediatric specialists

-understand the referral system in place

-case selection

communication

-smile- when you see parents, at child, eye contact

-learn their names

-listen

-be very specific

-avoid accusation

-include parent in decision making, do not decide treatment for them - address fears

-consistency of message

cultural awareness

-find a translator (not family, not child)

-assure translator conveys tone

-don’t assume someone who speaks the language is a good interpreter

-look at person and talk, then pause for interpreter → don’t just simply talk to interpreter

-do not need to know everything- some knowledge of larger groups within a society may convey more sensitivity

-putting concern on child is most important

-give time to ask questions that may not be common

additional tips for pediatric appointments

-organization

-no lag time

-recognize individual tolerance levels

-some patients are better in the morning

-pivot/adjust based on behavior