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Managing behaviour in children: Measuring anxiety

Managing behaviour in children. Watch Paul Ashley explain more.
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So how do we measure anxiety? Because, obviously, forewarned is forearmed. The more we know, the better we can prepare. And there are different ways of measuring anxiety. You can look at– you can ask the parents, and just say, well, what do you think, are they anxious? Are they not anxious? You can look for behavioural measures. Are they gripping the chair? Are they running out screaming? Are they wriggling around, or writhing, or something like that? You can look at physiological measures. Does their heart rate go up? Does their blood pressure change? Do they start sweating? And finally, actually, you can ask the child themselves. OK, so let’s go through those. And the first is ask the parents.
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And actually the evidence is probably asking the parents isn’t the right thing to do. And really we should be asking the child themselves. Though clearly, with some children, particularly younger ones, that might be difficult. Ask the parents? We don’t tend to think that’s reliable anymore. So now we have behavioural measures. They are very subjective. It depends on the operator and what they think. Is this child scared? Is it not scared? It’s unreliable, but it’s probably the best we’ve got, for the really young children, for the under five. So when you look at studies, looking at things around sedation perhaps, often these behavioural measures, to see how anxious or not that the child is. Next to physiological measures.
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But, again, evidence is that they’re a little bit unreliable. And they need additional equipment as well. So you need to have a pulse oximeter or a blood pressure machine. And that equipment, by itself, can cause anxiety. So we don’t tend to use physiological measures either.
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So that leaves us with self reporting measures. And I’m not going to recommend one or go into the different types, but suffice to say that there are lots of them. The first was CFSS-DS, usually only useful, all of them, from children age six to seven and up, because you need a certain degree of understanding for them to be able to respond to the questions you have. About 14 different scales available, now, a lot of them with quite a good evidence base. So I think if you want to measure anxiety, probably self-report is the way to go, for the children above say, six or seven years of age. And I think you need to decide which of the scales you prefer.
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OK, so in summary. Don’t forget that managing children is also about managing the parents. Don’t forget that children are not little small people. They are completely different intellectually, developmentally, how they respond to stress, how they think, to adults. So you’ve really go to change how you manage patients, to really be sure you’re managing children in the correct way. I think my final take home is, think about measuring anxiety. You know, I don’t think dentists do this good enough. There are some good scales out there. There are some good evidence-based scales out there. And it would help you, hopefully, perhaps plan a session a little bit better, maybe guide you as to how you’re going to manage a particular child.
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And that’s it. Thank you very much.

More on managing behaviour, this time we’ll talk about anxiety. Do you measure anxiety? Does it help?

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Paediatric Dentistry for Non-Specialists

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