I. Opening remarksIf You Can't Beat 'em, Enjoy Them
Behavior Management from a New Perspective
(Formerly called "Make Children the Highlight of Your Day")
II. Paying Attention to Details-- Empowering
the Child
A. Show-Tell-Do
1. Kids need to know
what's going on
2. Helps create credibility
and trust
3. Eliminates unknown
(takes "charge" off of it)
4. Creates opportunity
for reframing situation for child
5. Examples
a. First visit sequence in my office
b. Extraction sequence
B. Terminology
1. Understandable= familiar
words for children
2. Non-threatening=
positive, descriptive labels
3. Simple= much more
basic than you think
4. Examples
a. Mandibular block injection
b. Fearful child
C. Focus attention on the patient (even if parent
is present)
1. Holds child's attention
2. Redirects child's
anxieties
3. Gets treatment completed
much more quickly
4. Verbally restructures
patient's experience
D. Feedback (to patient)
1. Concentrate on what's
going well
2. Be specific with
child's successes
3. Be honest with your
praise
4. Phrase everything
from positive side
E. Feedback (from patient)
1. Listen to understand
what the issue actually is
2. Act on only things
that you can change
3. Don't expect an immediate
response or change from child/parent
F. Appropriate appointments
1. Proper sequence of
treatment plan (all subject to individual plan)
a. Start with posteriors
b. Mandibular arch before maxillary
c. Half-mouth treatment whenever possible
d. Pain may dictate plan
e. No more than three restorative visits/otherwise possible OR
2. Time of day according
to age
a. Earlier visits for younger kids
b. No operative visits in afternoon
3. Length of appointments
a. Usually 15-30 minutes for younger children
b. Should not exceed one hour
G. Use of other specialists
1.
More efficient care
2.
With oral surgeons, use or general anesthetic
III Managing the Person in the Mirror--- Empowering
the Self
A. Primary source of Behavior Management
is internal
1. Nobody can "make
them do it"
2. Your expectation
will usually be met
a. Hold child as able to succeed
b. Assume every visit for every patient will be perfect
3. Pay attention to
what you can control-- result is management of the patient
4. Dentist sets the
tone and the Team must understand and support philosophy
5. Every single action
in a practice is creating managed behavior
B. Be in charge
1. Care enough for the
child to provide guidelines
a. Children need limits and boundaries and often are relieved to have them
b. Allowing children to control an appointment is also a learning experience!
2. Any behavior is not
OK
3. Establish behavior
guidelines and be consistent
4. Examples
a. Resistant behavior
b. Inappropriate behavior
C. Positivism
1. Nothing sets the
tone of a practice as much as this
2. Breaks negative mindset
around dentistry (especially for parents)
3. Care-giver's confidence
is more critical than technical skills
4. Requires less energy
than negativism
5. Examples
a. Stay open vs. don't close
b. Hold still vs. don't move
D. Calmness
1. Voice modulation
a. Vocal anesthetic can be numbing, too!
b. Monotone has a hypnotic effect
c. Quietness forces the child to listen more carefully
2. Facial expressions
a. Effective even without words
b. Even infants respond to facial expressions
c. Good when there is a language barrier
3. Creates a sense of
security for the child
4. Slow nasal breathing
a. Keeps provider's heart rate and blood pressure lower
b. Encourages nasal breathing by patient
E. Honesty
1. Don't mislead or
make faulty promises
2. Know your own limits
(including important words: "I don't know")
3. Acknowledge child's
and/or parent's feelings
4. Kids have tremendous
BS detectors in case you try to fake it
IV. Allies, NOT Enemies-- Empowering the Parents to
Assist Their Children's Care
A. Your first job is to be sure the parents
feel heard by you-- establish credibility
B. Educate them and answer their questions
1. Be sure to understand
their concerns and answer the right question!
2. Never patronize them--
speak clearly and without condescension
3. Encourage any show
of interest
4. Ask for feedback
and be sure they are understanding you
C. Prepare them and set guidelines-- teach
them positive behavior
1. Prepare them for
their children's visits
a. Explain your techniques of empowering their children
b. Outline the procedures that are to be done
2. Set clear guidelines
around operative appointments
a. Be optimistic, but realistic
b. Acknowledge potential areas of difficulty
c. Discuss strategies
d. Make agreements regarding their role
3. My office's guidelines
a. Do not over-prepare the child
b. Use our terminology
c. Be a silent observer only
d. Leave when asked (this must be agreed upon up front)
D. "Difficult" parents
1. Prepare parents prior
to any visit to your office
2. Tell them directly
if they are not helping
3. Make clear boundaries
about leaving the room if child is acting out
4. Be OK with asking
them to leave your practice!!
E. Feedback (from parent)
1. Listen to understand
what the issue actually is
2. Act on only things
that you can change
3. Don't expect an immediate
response or change from parent
F. Model appropriate behavior at all times--
see feedback to patient (II-D)
©PSILENT PRODUCTIONS, 1998
SUGGESTED READING LIST
Chopra, Deepok, M.D., Quantum Healing, Exploring the Frontiers
of Mind/Body
Medicine,
Bantam Books, 1989
Chopra, Deepok, M.D., Perfect Health, The Complete Mind/Body
Guide, Harmony
Books, 1991
Covey, Stephen R., The 7 Habits of Highly Effective People, Simon and Schuster, 1990
Fields, Rick, Chop Wood, Carry Water, J. P. Tarcher, 1984
Hammerschlag, Carl, M.D., Theft of the Spirit, Simon and Schuster, 1993
Jampolski, Gerald G., M.D., Love is Letting Go of Fear, Bantam Books, 1979
Millman, Dan, Way of the Peaceful Warrior, H J Kramer, Inc, 1980
Millman, Dan, No Ordinary Moments, H J Kramer, Inc, 1992
Peck, M. Scott, M.D., The Road Less Travelled, Simon and Schuster, 1976
Rosemond, John, The Six Point Plan for Raising Happy, Healthy
Children,
Andrews and McMeel, 1989
Rosemond, John, A Family of Value, Andrews and McMeel, 1995