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‫بسم هللا الرحمن الرحيم‬

College of Dentistry

Pedodontic I

Psychological management of child


behavior -1-

Dr. Hazem El Ajrami


• The successful outcome of all procedures in
pedodontics depends on the ability of the
dentist to manage the child.
• Behavior Management: it is the means by
which the dental health team effectively
performs treatment for a child and at the same
time instills a positive dental attitude.
• Psychological (non - pharmacological)
management:
Management of the child in the dental office is
of fundamental importance. Although, many
children can be easily managed, yet, some show
extreme behaviors and are hard to manage.
Therefore, the pedodontist must have knowledge
about the psychology, growth and development of
children. As well as, knowledge about social,
cultural and medical factors affecting health and
behavior of young people. All these points are
important considerations that allow the dentist to
judge and change any abnormal behavior in the
dental office.
• A major difference between treating adults and
children is the relationship. Treating adults
involve one-one relationship (patient dentist),
whereas treating the child patient relies on one-
two relationship between dentist and patient as
well as parent. We call this relation the
pedodontic triangle which is child, dentist, and
parent relationship, with the child on the top of
this triangle.
Pediatric Patient Triangle

Pediatric patient

Parent Dentist

Arrows placed as communication lines to


remind us that communication is reciprocal.
• Childhood development:
A dentist who is aware of children's
abilities at various ages can use this
information to communicate at the child's
level. Therefore, it is helpful to become
acquainted with certain developmental
milestones in the life of the child.
Developmental milestones are relating
physical changes to specific chronologic ages.
A. Before two years old:
The child lacks rational response and
sufficient cognitive development. He can
express fear, joy and anger. He grows
emotionally by exploring the boundaries of
his environment.
B. Two years old child:
 His vocabulary increases and can make his
own needs known.
 Has short attention span.
 Fears falling down and sudden movements
so, the dental chair must be moved slowly.
 Too young to be reached by words, and the
way of communication must be emotional.
 He should be accompanied by the parents.
 He is likely to cry in any new situation, as he
cries the dentist can accomplish his work.
C. Three years old:
 At this age, the child becomes semi-
independent.
 Can form sentences.
 Likes praise, and he knows that there is a
reward for good behavior.
 Me-too stage and imaginative.
 Feels more secure with the parents.
 Fears strangers.
 Can be reached by words.
D. Four years old:
 This age is called the How and Why age.
 The child becomes a great talker and tends
to show-off.
 He enjoys his playmates and his
possessions.
 Much more independent.
 Cooperative with the dentist and it is the
most pleasant age.
 Fears unknown but fear of strangers
becomes less.
 Likes praise.
E. Five years old:

 The fear gradually decreases.

 Likes praise and comments on his clothes


and appearance.

 Can be reached through explanation.

 Never lie to him.


F. Six years old:
 By this age, the child has entered school
and has friends.
 His teacher becomes another authority.
 The fear may increase at that age but can
be rationalized.
G. Seven years old:
 Usually independent of parents.
 More attached to friends.
 Can be managed by explanation.
H. Seven to Twelve Years: From 7 to 12 years
the child is physically and intellectually more
capable of dealing with situations that might
create anxiety.
These descriptions are only generalizations,
and therefore the dental team must be prepared
to deal with the child patient whose behavior
might differ. It is possible to have a child in the
dental chair who, chronologically, is 10 years
old, intellectually, 7 years old, and emotionally,
5 years old.
• Child behavior patterns:
The children's behaviors in the dental office
classified into:
1. Cooperative behavior:
This child is relaxed and show minimal
apprehension. He displays a reasonable level of
cooperation, which allows the dentist to
function effectively and efficiently.
2. Lacking cooperative ability:
This category includes young children less
than two and half years old and mentally
handicapped children. The dentist cannot
establish communication with them.
3. Potentially uncooperative behavior:
This category has a behavioral problem,
which can be modified, and can be sub-
classified into:
A. Hysterical or uncontrolled:
Usually three years old children show this
behavior. They cry loudly with tears, they show
physical lashing out and temper tantrums. They
can affect the behavior of other children in the
office.
B. Defiant or obstinate:
Usually a stubborn or a spoiled child. Defies
the dentist. Screams loudly but with no tears.
Rarely talks, and when he speaks he says: “I
won't open my mouth”.
C. Timid:
This child hides behind his mother. He
looks down to the floor.
Usually whimpers but doesn't cry. Doesn't
respond to most of the commands.
D. Fearful:
An apprehensive child, his heart beats fast,
cries quietly. He resists a little but usually
obeys the dentist, and responds to praise. The
type of fear is usually subjective.
• Factors influencing child's dental behavior:
A. Maternal (parental) anxiety.
B. Extreme parental attitudes.
C. Past medical history.
D. School.
E. Fear and anxiety.
F. Physical condition of the child.
A. Maternal (parental) anxiety:

There is a significant correlation between


maternal anxiety and a child's cooperative
behavior at the first dental visit. Highly anxious
parents tend to influence their child's behavior
negatively.
B. Extreme parental attitudes:
1. Over protection:
The mother interferes in the child's life and
assists him in everything. Prevents natural
attitude of the child into dependence and leads
to a shy delicate child who lacks courage in the
dental office.
2. Over indulgence:
The parents yield to all the child desires. The
child becomes spoiled, selfish and stubborn.
Extreme indulgence results in a defiant child in
the dental office.
3. Over authority:
The parents demand from the child
excessive responsibilities more than his
chronological age by competition with older
children. This child is tense and restless in the
dental office.
4. Over affection:
It occurs in case of only child, youngest in
the family or in case of late marriage. This
child lacks courage in the dental office.
5. Under affection:

Parents do not spend enough time with the


child because of work obligations, emotional
or socio-economical reasons. The child feels
insecure, and might develop bad oral habits.
In the dental office, he will be shy and cries
easily.
6. Rejection:

This is an extreme behavior which occurs


as a result of an emotional problem such as
jealousy, or in case of immature parents, or
financial burden due to increased number of
children. The child becomes selfish, restless
and disobedient.
C. Past medical history:

Children with positive medical experience


respond cooperatively in the dental office. Pain
experienced during previous medical visits is
an important consideration. Also, previous
surgical experience adversely influences
behavior at the first dental visit.
D. School:
Children attending nurseries or preschool
can adapt themselves to various dental
problems. Children in schools have more
dental knowledge, but can have misleading
stories about dentistry. The school can be
useful in providing proper dental information
to children.
E. Fear and anxiety:
Fear: is one of the primary emotions. It is a
protective mechanism about danger. Fear
must be channeled towards danger e.g. fear
from caries not from dentist.
• Types of fear:
 Real or true fear.
 Emphasized or not true.
 Anxiety.
 Real or true fear:

1. Subjective fear: due to experience of other


persons, suggested to the child if he hears
stories about dentistry from his friends or
parents. The child's imagination magnifies
the fear.
2. Objective fear: results from personal exposure
to pain or discomfort. A painful tooth can be
associated with fear from dentist. A previous
dental experience can be the cause of this fear.
Also, the child might fear hospitals or persons
in white due to a previous medical experience.
3. Needle pain fear: If the child was subjected to
previous therapeutic injections or vaccinations.
 Emphasized or not true:
1. Fear of unknown: it is a common trait in all
human beings. All unknown situations are
fearful until experienced.
2. Fear of strangers (dentist, assistant).
3. Fear of separation from the parents.
 Anxiety: is a personality trait in which there is
increase in tension, apprehension and
uneasiness due to unknown causes.
F. Physical condition of the child:
I. Sick child (chronically ill):
This child is more likely to be cooperative,
but those with a negative experience are
uncooperative. They are usually over
indulged. Hospitalized children develop the
spirit of “I can take it too”.
II. Nutrition:
Children with vitamin deficiency show
irritability, fatigue and restlessness.
III. Physical and mental fatigue:
Lack of sleep or exhaustion is turned into
poor behavior in the dental office. Therefore,
morning appointments or those after naptime
are the appointments of choice.
• There are other co-factors, which play a role in
affecting the child behavior in the dental
situation such as:
1. The time and length of the appointment.
2. The appearance of the dental office.
3. The personality of the dentist and his assistants.
4. The knowledge about the patient.
5. The intelligence of the child.

6. The use of fear promoting words.

7. The dentist skill and speed.

8. The use of praise.

9. Giving gifts at the end of every visit.


Thank You