behavior lab[1]

8/2/2019 Behavior Lab[1]

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Behavior management

in children


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Definition

Behavior management: The means bywhich the dental health team effectively and

efficiently performs treatment for a child.


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Children often have anxiety or fear

when they experience something new.

If they have had a bad experience orare very nervous, it is our job to help

them overcome their fears and help

them realize that they can do it

(MODIFY THEIR BEHAVIOR)


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The three main goals of behaviormanagement are:

1.

first to help a child feel relaxed andconfident,

2. second to guide a child in coping with dental

treatment and3. third to complete dental treatment as quickly

and safely as possible.


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Behavior management techniques

Preparatory information.

Non verbal communication.

Voice control.Tell-show-do (TSD)

Enhancing control


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Behavior management techniques

Behavior shaping and positive reinforcement.

Modeling.

Distraction Systemic desensitization

Negative reinforcement (Hand over mouth)


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Preparatory information

Usually in the form of a letterwelcoming the patient and familyto the practice.

Such letters will inform thefamily about what will happen atthe visit, give advice aboutPREPARING THE CHILD

and also reduce PARENTALANXIETY.


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Non-verbal communication

having a child friendly environment

and a happy smiling team


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Non-verbal communication

Gentle pats, or squeezes on the shoulder

minimize stress.

Sitting and speaking at eye level allows forfriendlier and less authoritative

communication


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Voice control

Young children often respond to the tone of voicerather than the actual words.

Raise his voice and speak to a child firmlyStop crying

and pay attention It aims to improve attention and compliance as well as to

establish authority.

May not be acceptable to all parents or clinicians.

Not appropriate for children too young to understand orwith a mental handicap.


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Tell-Show-Do

The method involves verbal explanation of theplanned procedures (Tell),

demonstration of the visual, auditory, olfactory,and tactile aspects of the procedure in a carefullydefined, non-threatening setting (Show),

and then without deviating from the explanationand demonstration, completion of the procedure(Do).


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Remember to:

Introduce the simplest procedures first

Explain the procedures at the childs level Use words the child can understand

Involve the child


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Buzzy bee, motorcycle Slow speed handpiece

Mr. whistle, fast car High speed handpieceSleepy juice Local anesthetic

Spray your teeth off to sleep Giving a local anesthetic

Rubber raincoat Rubber dam

Clip or button Rubber dam clamp

Tooth paint Fissure sealant

Vacuum cleaner SuctionSilver star Amalgam

Wind gun/ water gun Air/ water syringe


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Enhancing control

Here the patient is givena degree of control over

their dentists behavior

through the use of a stopsignal, usuallyRAISINGAN ARM.


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Behavior shaping and positive

reinforcement

This technique REWARDS desired behaviors andthus strengthens the recurrence of those behaviors.A reward is given when the patient responds

desirably to your request. Remember to:

Identify target behavior

Select an appropriate reward for the patient

Reward the target behavior promptly andconsistently

Ignore undesirable behavior


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Behavior shaping and positive

reinforcement

Anything that the child findspleasant can act as a positivereinforcer; stickers or badges

are often used at the end of adental appointment.

The most powerful reinforcers

are social stimuli such as, facialexpressions, positive voicemodulations and verbal praise.


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Modeling technique

involves the modification ofbehavior by having a patient

observe another child who is

displaying appropriate behavior.This technique is based on thefact that children learn much of

their behavior from their peers,especially those of the same sex,age and status


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Distraction

This approach aimsto shiftthe patientsattention from the

dental setting to someother situation, orfrom a potentially

unpleasant procedureto some other action.


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Distraction

Short term distractors such as pulling the lip as alocal anesthetic is given may be helpful.

The distraction may be verbal, such ascontinuous conversation, or it may be visual,such as the use ofposters on the walls andceiling.


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Systemic desensitization

This technique helpsindividuals withspecific fears or

phobias overcomethem byrepeatedcontacts.


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Treatment plans can incorporate systematicdesensitization.

By starting with easier procedures, such assealants or restorations that do not involveanesthesia, the child is gradually introduced todental treatment.

Subsequent appointments can then be scheduledto introduce anesthesia, crown applications, orpulp therapy.


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Negative reinforcement

It is the strengthening of a pattern of behavior bythe removal of a stimulus which the individualperceives as unpleasant (a negative reinforcer) as

soon as the required behavior is exhibited.


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The stimulus is applied to all actions except therequired one, thus reinforcing it by removal of anegative stimulus.

Examples:

HOME

Selective exclusion of the parent


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Hand-Over-Mouth Exercise

(HOME)

It is used to reframe a previous request and to re-engage appropriate communication. Whenindicated, a hand is placed over the childs mouth

and behavioral expectations are calmly explained.The child is told that the hand will be removed as

soon as appropriate behavior begins. When thechild responds the hand is removed andappropriate behavior is reinforced.

The use of HOME requires specific writtenconsent from parents prior to its use.


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(Selective exclusion of the parent)

Parental consent is required.

When inappropriate behavioris exhibited, the parent isasked to leave.

The parent may be used as abargaining tool for the child

to behave on the chair If youwant Mommy beside you, youhave to stop crying.


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(Selective exclusion of the parent)

Ideally, the parent should be able to hear, but beout of sight of the child.

When appropriate behavior is exhibited, theparent is asked to return, thus reinforcing thatbehavior.

Contraindicated in children less than 4 years


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behavior lab[1]

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