3. Using parents as leverage
5. Aversive techniques – HOM
1. Nitrous Oxide-Oxygen
2. Sedation's : Oral, IV
· Developed by Addelston in 1959.
· Tell it !
· Show it !
· Do it !
· Always be honest !
· Never sneak things up on kids !
Parental LeverageParental Leverage
· Sometimes, need to use parents as leverage to obtain appropriate behavior.
· Get informed/implied consent from parents.
· Explain procedure to the parents first.
· Parents sent out immediately when child cries.
· Bring parent back when child stops crying.
· Use an older sibling or child to model for an apprehensive patient.
· Best to use someone they look up to.
· Very effective in families that have 2 or more kids.
· Can be used for anesthesia administration.
· Informed consent prior to use.
· Human - parents, assistant.
· Sensitive about the use of the word.
· Can be called a “positioner”.
e.g. : Papoose Board, Pedi-Wrap, Molt
mouth props etc.
· Hand over Mouth and Airway - not used anymore.
· Hand over Mouth Exercise (HOME) only.
· Informed consent must be obtained prior to use.
· Never use on a frightened child.
· Rarely used. Legal Issues.
Hand Over Mouth Technique
· Used for an extremely uncooperative-defiant-hysterical child.
· Hand placed over the mouth to muffle screaming.
· Talk very softly close to the ears.
· Place hand back if child starts screaming again. Keep repeating until cooperative.
· Always be in control of your emotions.
1. Nitrous Oxide-Oxygen
3. Conscious Sedation
4. General Anesthesia
Nitrous Oxide-OxygenNitrous Oxide-Oxygen
· “Laughing gas”.
· One of the safest pharmacologic methods of behavior management.
· Very few adverse effects, easily removed from the lungs in <4 minutes.
· Special equipment required.
· Will not work for a defiant child.
· Cannot replace local anesthesia.
· reduce fear in an anxious or apprehensive patient.
· to raise the pain threshold.
· w/ conscious sedations.
· defiant child.
· to replace poor behavior management local anesthesia.
· upper respiratory infections.
· psychiatric disorders.
· h/o motion sickness and vomiting.
· Can give mild sedative night before or the morning of the appointment.
· Rarely done for very young children.
· Can be used to teenage children.
· Common Drugs: Valium
Conscious SedationsConscious Sedations
· Sedative drug (Oral/Nasal/IV/IM/ Rectal) + Nitrous.
· Special training required in several states.
· Patient is able to maintain their own airway. Can cry during procedure.
· Advantages : retrograde amnesiac properties of the drugs commonly used.
· Completely under, (Oral/Nasal) endotracheal tube to maintain respiration.
· Usually done in a Hospital.
· Anesthesiologist or anesthetic nurse required.
· Special training and hospital privileges required.
· extremely young child with rampant caries.
· handicapped children
· extremely fearful children
· any systematically complication condition e.g. congenital heart condition etc.
Written consentMedical clearance - Pediatrician, Anesthesia.
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