CHILD MANAGEMENT

Dr. Yosra Abdelfatah Ali

•Introduction
•Factors affecting the child behavior at the dental clinic
•Child Development
•Child Psychology
•Classification of Child Behavior
 Introduction

•Promote positive dental attitude and improve the dental health

•Treating a child on a one-to-two relationship among dentist,
pediatric patient, and parents or guardians.

•This relationship, is known as the pediatric dentistry treatment

triangle.
•The child is at the apex of the triangle.
•Communication between the three corners of the triangle is
reciprocal.
 Factors affecting the child behavior at
the dental clinic
•Factors involving the parents.
•Factors involving the dentist.
•Factors involving the child patient.

Factors involving the parents

•Family influence.
•Parent-child relationship.
•Maternal anxiety
•Attitude of parents to dentistry
•Presence of the parent during the treatment.
 Parent- child relationship that may
influence the child behavior in the
dental clinic:

Should parents join children in the

surgery?
1. The parent often repeats orders, annoying both the dentist and the child.
2. The parent intercepts orders, becoming a barrier to the development of
rapport between the dentist and the child.
3. The dentist is unable to use voice intonation in the presence of the parent
because he/she is offended.
4. The child divides his/her attention between the parent and the dentist.
5. The dentist divides his/her attention between the parent and the child.
6. Dentists are probably more relaxed and comfortable when parents remain
in the reception area
 The advantages:

1. Emotional support for the child.

2. Help for the special needs children.
3. Increasing communication efficiency.
4. Reassure both the child and the parent.
5. Parents can hear the educational instructions provided to the
children.

Factors involving the dentist

Fundamentals of behavioral guidance
•Positive approach: anticipate the success!
•Team Attitude: smiling , nickname hobbies ,..etc
•Organization: everyone in the team should know his exact role.
•Truthfulness: To succeed gain your child patient’s trust, assurance!
•Tolerance: Cope rationally with misbehaviors while maintaining
composure.
•Flexibility: You may need to change the treatment plan and the
operating position.

COMMUNICATING WITH CHILDREN

•Establishment of Communication: Conversation not only enables
the dentist to learn about the patient but also may relax the younger
children.
•Establishment of communicator : Directions from more than one
person at a moment will confuse the child.
•Message clarity
•Voice control
•Multisensory Communication
•Problem Ownership
•Active Listening
•Appropriate Responses

•People like friendly dentists

•A calm warm tone coupled with open body language and when
appropriate a smile is more reassuring to an anxious parent
 Structure of the dental consultation
1-Greeting.
2. Preliminary chat.
3. Preliminary explanation.
4. Business.

Structure of the dental consultation

5. Health education.
(a) Make the advice specific.

(b) Give simple and precise information.

(c) Do not suggest goals of behavior change which are beyond a patient’s capacity
to achieve.
 Structure of the dental consultation
(d) Check that the message has been understood and not misinterpreted.
(e) Offer advice in such a way that the child and parents are not threatened or
blamed.
(f) If you are trying to improve oral hygiene avoid theoretical discussions. offer a
practical demonstration.
(g) At follow-up visits reinforce the advice and offer positive reinforcement

6. Dismissal.
Ensure that wherever possible the patient and parents leave with a
sense of goodwill.
 VARIABLES INFLUENCING
CHILDREN’S DENTAL BEHAVIORS
.

•Parental Anxiety
•Toxic stress
•Medical experiences
•Awareness of Dental Problem
•General Behavior Problems
•Position of the child
•Dental office environment

Child Development:
-Human development is not unitary.
-Motor, perceptual, Language, cognitive, and social
development
Motor
•Genetic and environment influences.
•By the age of 2 the majority of children can walk on their own.
•Children aged 6-7 years have sufficient coordination to brush their
teeth.
 Perceptual development
Compared with adults
• 6-year-old children cover less of the object, fixate on details, and
gain less information.

• By the age of 7 years can determine which messages merit attention

and which can be ignored. Concentration skills also improve.

• With increasing age children become more efficient at

discriminating between different visual patterns and reach adult
proficiency by about 9 years of age.

Language development
• Newborn children show a remarkable ability to
distinguish speech sounds, and by the age of 5 years
most children can use 2000 or more words.
• The key to successful communication is to pitch
your advice and instructions at just the right level
for different age groups of children.
Social development

-Interaction with environment (home, school and

community).

Separation anxiety

-At about 8 months infants show a definite fear of

strangers.
-This potential for anxiety separation remains high until
about 5 years of age.

Adolescence
There is increasing independence and self sufficiency.
Moody, oversensitive to criticism, and feel miserable for no
apparent reason.

Don’t criticize them.

 CHILD PSYCHOLOGY

Is the science that deals with mental power or an interaction through

the conscious and subconscious element in a child.

Why to study child psychology ?

• For better understanding of child therefore deal with him more
effectively and efficiently.
• To identify the problems of psychosomatic origin.
• To train the child to understand his own oral hygiene.
• Helps in modifying child’s developmental process.
• For better planning and interaction between treatment plan.
Theories Of Child Psychology
Classification of child psychology theories :
Psychodynamic theories
•Psychoanalytic theory by Freud
•Psychosocial theory by Eric Erikson.
•Cognitive theory by Piaget

Behavior learning theories

•Classical conditioning theory by Ivan Pavlov.
•Operant conditioning theory by BF Skinner.
•Social learning theory by Albert Bandura.
•Hierarchy of needs by Maslow
 • Theory of cognitive development
This theory of JEAN PIAGET (1952) Based on how children and
adolescents think and acquire knowledge.

PIAGET formulated the 'stages view' of cognitive development.

He suggested that children pass through four broad stages of cognitive
development, namely:
•The Sensorimotor Stage
•The Preoperational Stage
•The Concrete Operational Stage
•The Formal Operational Stage
 1. Sensorimotor (0-2 years):
•Object permanence.
•Behaviors are limited to simple motor responses caused by sensory
stimuli.
•Children utilize senses, such as looking, sucking, grasping, and
listening, to learn more about the environment e.g. mouthing of
objects.
•Can be given toys while sitting in dental clinic or chair.

2. Preoperational thought (2 to 7
years):
•Child can predict behavior outcomes.
•Egocentric, unable to encompass another person's point of view.
•Inflexible
•Language development is one of the hallmarks of this period.
•Thought patterns are not well developed
•Child explained about equipment and allowed to deal with it.
•ANIMISM: Correlates with other familiar objects
 3. Concrete operations (7-11 years):
•Children are able to apply logical reasoning.
•Consider another person's point of view.
•Assess more than one aspect of a particular situation.
•Thinking is rooted in concrete objects, abstract thought is
not well developed.
•Allow the child to hold mirror to see what is happening.
 4. Formal operations (11 years and
more):
•Transition to adult thinking ability.
•Logical abstract thinking so that different possibilities for action
can be considered.
•Abstract thought: Possible outcomes and consequences of actions.
•Problem solving: Able to quickly plan an organized approach to
solving a problem

Classification of Child
Behavior
The term behavior is broadly used to include
the entire complex of observable and
potentially measurable activities including
motor, cognitive and physiological classes of
response.
 CLASSIFICATION OF CHILD BEHAVIOUR AS
OBSERVED IN DENTAL CLINIC

•WRIGHT’S CLASSIFICATION

•Frankl’s Behavioral Rating Scale

•LAMPSHIRE CLASSIFICATION

•WILSON’S CLASSIFICATION

WRIGHT’S CLASSIFICATION
•Cooperative
•Lacking in cooperative ability
•Potentially cooperative
 WRIGHT’S CLASSIFICATION
• Cooperative
•Reasonably relaxed
•Have minimal apprehension
•May even be enthusiastic
•Can be treated by a straightforward

Lacking in Cooperative Ability

•Very young children
•Debilitating or disabling conditions.
•Physical and mental handicap children
are also included under this.
Potentially Cooperative
•Has the potential to cooperate.
•Uncontrolled, defiant, timid,
tense-cooperative.

Frankl’s Behavioral Rating Scale (1962)

The scale divides observed behavior into four categories, ranging
from definitely positive to definitely negative.
 Wright modification to Franklin’s
classification
Wright in 1975 added symbolic classification to the
Frankl’s scale and made it more applicable and easier to
understand child behavior:
➢Rating no.(1): Definitely Negative (--).
➢Rating no.(2): Negative (-).
➢Rating no. (3): Positive (+).
➢Rating no. (4): Definitely positive (++).

Rating 1: Definitely negative.

Refusal of treatment, forceful crying, fearfulness, or any other overt
evidence of extreme negativism
Rating 2: Negative.
Reluctance to accept treatment, uncooperativeness, some evidence of
negative attitude but not pronounced.
• Rating 3: 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.

• Rating 4: Definitely positive.

Good relationship with the dentist, interest in the dental procedures, laughter
and enjoyment.
Behavior management can be achieved basically by two methods:
•Non-pharmacological methods.
•Pharmacological methods.

All the best in success