24: The uncooperative child

24 The uncooperative child

Summary

Liam is 5. He is shaking and tearful as he is brought into the surgery. His mother says he has been in pain from his teeth for a long time. How would you manage Liam and his dental treatment?

image What do you understand by the term behaviour management?

Based on scientific principles, the proper implementation of behaviour management requires an understanding of these principles. It requires skills in empathy, communication, coaching and listening.

The goals are to establish communication, alleviate fear and anxiety, deliver quality dental care, build a trusting relationship between dentist and child, and promote the child’s positive attitude towards oral/dental health.

All decisions must be based on a benefit versus risk evaluation. Parents/legal guardians share in the decision-making process regarding treatment of their children.

image What history is important in Liam’s case?

Liam’s dental history. It is crucial to identify any previous episodes either at the dentist, doctor or hospital, usually involving needles that may have frightened him. If there are no previous precipitating factors he may have been frightened by stories or comments from his peers or family.

Family dental history. Parental fear, and a negative attitude toward dental and oral health, can significantly affect the cooperation of a child.

Liam’s development. Delayed development and poor cognition can affect the ability of a child to understand what you are trying to do to help. Children with a negative image of themselves who have never succeeded well at anything will be more difficult to treat. They often give up because they ‘never succeed’ and are often called ‘failures’ by their parents or peers.

Communicative management is the most fundamental form of behaviour management. It is the basis for establishing a relationship with a child that will allow you to successfully complete dental procedures and help the child develop a positive attitude toward dental health.

image What main forms of communicative management are there?

Voice control.
Non-verbal communication.
Tell-show-do.
Positive reinforcement.
Distraction.
Parental presence/absence.

Voice control

Description: Voice control is a controlled alteration of voice volume, tone or pace to influence and direct the patient’s behaviour.

Objectives:

To gain the patient’s attention and compliance.
To avert negative or avoidance behaviour.
To establish appropriate adult–child roles.

Indications: May be used with any patient.

Contraindications: None.

Non-verbal communication

Description: Non-verbal communication is the reinforcement and guidance of behaviour through appropriate contact, posture and facial expression.

Objectives:

To enhance the effectiveness of other communicative management techniques.
To gain or maintain the patient’s attention and compliance.

Indications: May be used with any patient.

Contraindications: None.

Tell–show–do

Description: Tell–show–do is a technique of behaviour shaping used by many paediatric professionals. 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 non-verbal) and positive reinforcement.

Objectives:

To teach the patient important aspects of the dental visit and familiarize the patient with the dental setting.
To shape the patient’s response to procedures through desensitization and well-described expectations.

Indications: May be used with any patient.

Contraindications: None.

Positive reinforcement

Description: In the process of establishing desirable patient behaviour, it is essential to give appropriate feedback. Positive reinforcement is an effective technique to reward desired behaviours and thus strengthen the recurrence of those behaviours. Social reinforcers include positive voice modulation, facial expression, verbal praise and appropriate physical demonstrations of affection by all members of the dental team. Non-social reinforcers include tokens and toys.

Objective:

To reinforce desired behaviour.

Indications: May be useful for any patient.

Contraindications: None.

Distraction

Description: Distraction is the technique of diverting the patient’s attention from what may be perceived as an unpleasant pro/>

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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 24: The uncooperative child

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