24 The uncooperative child
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.
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.
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.
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.
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.