Lec6 Pedodontic Dr.

Nada Ali Alsharaa

Management of children behaviors

Behavior : it is an observable act which can be described in similar ways by more than one person.

Behavior Management : Is the means by which the dental health team effectively and efficiently
performs treatment for a child and, at the same time, instills a positive dental attitude. Effectively in this
definition refers to providing high quality dental care. Efficient treatment is a necessity in private
practice today. In another words behavior management mean methods used to make the child accept
treatment in the dental chair beside educate the child and be sure that he will come again for the next
appointment.

Dental fear : is considered the primary source of both DBMP and irregular dental care.

Fundamentals of behavior management:

1- The team attitude
2- Organization
3- Positive approach
4- Truthfulness
5- Tolerance
6- Flexibility

Management Techniques:

 Communicative Management Approaches (Non-Pharmacological Techniques):

A. Psychological Approach:
 Pre-appointment behavior modification
 Communication
 Use of 2nd language
 Behavior shaping
 Tell-Show-Do
 Reinforcement
 Modeling
 Voice control
 Visual imagery
B. Physical approach:
 Hand-Over-Mouth
 Physical restraint
 Sedation And General Anesthesia (Pharmacological Techniques)
 Relative analgesia
 Oral sedation
 Intravenous sedation
 General anesthesia
Lec6 Pedodontic Dr. Nada Ali Alsharaa

Aims Of Behavior Management

To increase appropriate behavior and decrease inappropriate behavior in order to:

 Foster a positive attitude to dentists, dental health and dental treatment.

 Perform the necessary treatment

Assessment of child development:

There is no specific measure can be used accurately to know child's developmental status. But certain
questionnaire completed in the clinic which screening the major area of child development can give the
dentist information about:

1. Behavioral adjustment
2. Child mental age level.
3. Social majority level.
4. Physical status.
5. History of medical problem.

Variables Influencing Children's Dental Behaviors

1. Psychological development of the child

2. Parents influences
3. Fear and anxiety
4. Physical condition of the child
5. Awareness of dental problem
6. School and dental experiences of others
7. Other variables:
 Socio-economic
 Sibling relationship
 Number of children
 Ordinal position
8. Other Co- Factor: dentist

The pattern of behavior at certain age with expected psychological development:

 At 2 years: At this age the child called in the pre-cooperative stage and they vary greatly in their
ability to communicate (terrible twos).
 At 3 years: The child can communicate more easily than 2 years old. But they need their
parents to remain with them in clinic to feel more security.
 At 4 years: The child usually listens and has a response with interest to dentist explanation and
verbal direction.
 At 5 years: The child will have no fear of new experience if he properly prepare by the
parents.
 At 6 years of age: The child need proper introduction about dental treatment so he will
respond in a satisfactory manner because the tensional manifestation rises to peak at this age
Lec6 Pedodontic Dr. Nada Ali Alsharaa

Parents influences:
 Extremes of parental attitude:
1. Over-affection
2. Over-protection
3. Over-indulgence
4. Over –authority
5. Under -affection
 Abnormal parental attitude in dental office:
1. Parental anxiety
2. Manipulative parents
3. Hostile parents
4. Neglected parents

Physical condition of the child

 Sick
 Nutrition
 Physical or mental fatigue

Awareness of dental problems :

A negative behavior may develop when the child recognize that a dental problems exists .

School influences : positive / negative

Fear and anxiety :

Fear : is the state of apprehension based upon concrete experience and memories

Anxiety : general apprehension due to unknown or new situation

Types of fears:

1. True fear :
 Objective fear
 Subjective fear
 Needle pain fear
2. False fear
 Fear of unknown
 Fear of strangers
 Fear of separation from parents
Lec6 Pedodontic Dr. Nada Ali Alsharaa

Communication with children

1. Establishment of communication
2. Establishment of the communicator
3. Message clarity
4. Voice control
5. Multisensory communication
6. Problem ownership
7. Active listening
8. Appropriate response

Behavior shaping
Behavior shaping: it is the procedures which very slowly develops behavior , by reinforcing successive
approximation of the desired behavior until the desired behavior comes until the desired behavior
comes to be.

Role of behavior shaping : teaching the child how to behave so that the young children are led through
this procedure , step by step .

Techniques of behavior shaping :

 Pre-operative preparation : to remove any unfavorable images in the child's mind and decrease
the fear from the unknown
 Behavior shaping: the aim of it is that the child is gradually trained to accept treatment in a
relaxed and cooperative manner
 Voice control : it is a controlled alteration of voice that used in certain situation.
 Non-verbal communication :
1. Physical communication
2. Visual communication

Used to enhance the effectiveness of other communication techniques and to gain and
maintain the patient's

 Tell –show – do :
1. Tell : verbal explanation of the procedures in simple phrases appropriate
2. Show: demos of the visual –auditory and tactile aspect of the procedures .
3. Do : perform the explained (tell) and demonstrated (show) procedures .
 Positive reinforcement : to strengthen the recurrence of desired behavior in future
 Distraction : in order to decrease the unpleasant perception and change the negative behavior
as the child start thinking about something different from the dental treatment
 Parental presence / absence
 Desensitization : used for treatment of fear
 Modeling : act as stimulus to a good behavior and eliminate the fear
 Permitting the child sense of control .
Lec6 Pedodontic Dr. Nada Ali Alsharaa

Classification of Children's Cooperative Behavior

Numerous systems have been developed for classifying the behavior of children in the dental
environment.

 Wright's clinical classification places children in three categories:

 Cooperative
 Lacking in cooperative ability
 Potentially cooperative
 Frankl Behavioral Rating Scale. The scale divides observed behavior into four categories,
ranging from definitely positive to definitely negative. Following is a description of the scale:
1. Rating1: Definitely Negative. Refusal of treatment, forceful crying, fearfulness, or any
other overt evidence of extreme negativism.
2. Rating2: Negative. Reluctance to accept treatment, uncooperativeness, some evidence
of negative attitude but not pronounced (sullen, withdrawn).
3. Rating3: Positive. Acceptance of treatment; cautious behavior at times; willingness to
comply with the dentist, at times with reservation, but patient follows the dentist's
directions cooperatively.
4. Rating4: Definitely Positive. Good rapport with the dentist, interest in the dental
procedures, laughter and enjoyment.