If You Can't Beat 'em, Enjoy Them
Behavior Management from a New Perspective
(Formerly called "Make Children the Highlight of Your Day")
  I. Opening remarks
     A. Nature of this course
         1. Have fun looking at ourselves and issues
         2. Unorthodox for dental course
             a. There are no recipes for success/ course is interpretive
             b. There are few black and whites/ grays call for judgement
             c. Information is in audience's mind, not the speaker's
         3. The course is to stimulate thought, not provide definitive answers
         4. Principles discussed today are applicable to all parts of one's life
         5. The thrust of the program is to experience the patient's perspective
         6. No note taking is strongly recommended
      B. Importance of Behavior Management in practice and in people's lives
         1. Tremendous practice builder
             a. Manage a child and capture an entire family
             b. Financially lucrative once child's behavior is managed
         2. Behavior Management is the ultimate preventive tool
         3. It is the most profound non-dental impact we have
             a. Provides a chance to "make a difference" in today's complex society
             b. Terrific opportunity to practice principles for our own children at home!
         4. Access to care could make it mandatory to provide care to children.
         5. Tremendous source of satisfaction beyond financial gain
      C. Exercises
         1. Demonstration of Behavior Management principles in this room
         2. Safe, but might be scary for participants
         3. Success lies in each individual's experiences and willingness to notice effects
         4. Full-participation is strongly recommended to get full benefit

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)



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            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

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