The Emotional development of a child.pptx

This presentation discuss about emotional development of a child at various stages of life

1. EMOTIONAL DEVELOPMENT DEPARTENT OF PEDIATRIC & PREVENTIVE DENTISTRY BDS Fourth Year lecture Dr. Rishabh Kapoor Reader (Pediatric and Preventive Dentistry) 29/4/2024

2. Teaching Objectives To introduce students to the concept of emotional development in children To give a brief review of emotions and their implication during dental procedures Types of fear, anxiety and phobias that develop or persist in children

3. CO N TENTS Introduction Definition Types of emotions Important of Emotional Development Physiology of emotion Characteristics of commonly seen emotion in a child Distress or Cry Anger Fear Anxiety Phobia

4. Introduction Each of us is born into society with rules, expectations, attitudes, and values. Our task throughout development is to come to understand ourselves, how we feel and function, and what our society deems desirable and appropriate. The e m otional de ve l o p m ent of children and adole s ce n t represent a huge variation according to age, maturity, intellectual development, temperament, experience , family background, cultural background etc.

5. These factors play an important role in influencing the child’s development and underlying emotions. Concurrently , these aspects influence the child’s ability to cop with dental treatment. According to their age and emotional development some children remain calm during the treatment , while others are vulnerable and may need more attention and time in order to make them cooperate for dental treatment.

6. Definition Emotion: An effective state of consciousness in which joy, sorrow, fear, hatred or the likes are expressed. Emotional development is the developmental process of the child’s ability, to control their feelings.

7. IMPORTANCE OF EMOTIONAL DEVELOPMENT

8. Emotional security = Happy child POSITIVE MOTION Affection, amusement, joy, curiosity and happiness Essential to normal development. NEGATIVE EMOTION Fear, anger, jealousy Harmful to development

9. Infancy Early adulthood Late adult hood Distress Anxiety Grief Startle response Fear Worry S h ame Self pit Anger Guilty feeling Disgust Depression Jealousy Irritability Disappointment boredom Restlessness Joy Delight Elation Mystical Hopeful anticipation Ecstasy Affection Possessive Satisfaction Benevolence Different emotions at different stages of life

10. PHYSIOLOGY OF EMOTION Development of emotion depends on maturation in the nervous system and the endocrine system. Differences in emotional responsiveness between children and adults appear to be partly due to cortical immaturity and partly due to d i f f er ence in endocrine out put. At the birth cortex development is completed, frontal lobe is immature and has little influence on the functions of the lower part of he brain resulting in imbalanced emotion. Hence, emotional response of the child is quickly aroused but short live d

11. The sympathetic system is active during aroused states and prepares the body for extensive action by increasing the hart rate, blood pressure, blood glucose level and raising the level of certain hormones in the blood. Parasympathetic systems, tends to be active when we are calm and relaxed.

12. Characteristics of commonly seen emotion in a child Distress or Cry Anger Fear Anxiety Phobia

13. Distress or Cry The most common way a child expresses fear is by crying at the dentist’s office. Cry i ng, li k e other e m o t ional m anife s ta t ions of h u m an behaviour is an expression of personality of an individual. It is the result of conflict with the developing ego and with his newly found interests. After the age of one and a half child develops a variety of fears and cries for the security of his mother’s company .

14. At birth: Primary emotion With vigorous body expression Usually due to hung e r , colic or any internal cause. At six months Greatly replaced by a milder expression of fussing or vocalization During preschool: Only for the reason of physical pain as he is disappointed by his environment During school year : pressure helps him to outgrow the crying habit which decrease rapidly. After this till 15 years crying occurs very seldom In young adult : limited to quiet crying in private only for reason of grief or other intense emotion

15. Type of cry seen i n children Following four type of crying are usually seen in children ( Elsbach , 1963) Obstinate cry The child throw a temper tantrum to thwart dental treatment It is loud, high - pitched Pause and repeated over and over again. Characterized as a siren like wail Represents the child’s external response to anxiety Frightened cry Usually accompanied by a torrent of tears. Convulsive breath-catching sobs Usually the child emitting this type of cry has been overwhelmed by the situation. Hurt cry May be loud and more frequent. Frequently accompanied by a small whimper Initially a child in discomfort shows a single tear filling the corner of the eye and running down the child’s cheek with out making any sound or resistance to the treatment procedure. Compensatory cry: It is not a cry at all It is a sound that child makes to drown out the noise, for example, a drill. Usually the cry sound is slow, monotone. It is a sort of coping mechanism to unpleasant auditory stimuli, finding himself uncomfortable in the situation.

16. ANGER Outburst of the emotion is caused by the child’s lack of skill in handling the situation . Infant and young children respond in anger in a direct and primitive manner but as they develop, the responses become violent and more symbolic .

17. FEAR…. Fear is a reaction to a known danger (augmenting the fight or flight response) Def: An unpleasant emotion or effect consisting of psychological changes in response to realistic threat or danger to one’s own experience. Dental fear (DF) is a normal emotional reaction to one or more specific threatening stimuli in the dental situation

18. FEAR ARISES IN ONE OF THE THREE WAYS

19. THE CHILD’S FEARS CHANGES WITH AGE

20. TYPE OF FEAR

21. INNATE FEAR  without stimuli or previous experience Dependent on the vulnerability of the individual OBJECTIVE FEAR Produced by direct physical stimulation of the sense organs and are generally not of parental origin. Objective fears are responses to stimuli that are felt, seen, heard, smelled or tasted, and are of a disagreeable or unpleasant nature. SUBJECTIVE FEAR Fear based on somebody else’s experience without actually undergoing dental treatment himself. The majority of the children who visit the dentist are anxious in particular during first visit. Their anxiety level may be heightened by stories from friends, relatives, parents who have threatened them using dentist’s visit as punishment for bad behavior.

22. SUGGESTIVE FEARS acquired by imitation by observation of other IMITATIVE FEARS transmitted while displayed by other (parent) and acquired by the child without being aware of it. Displayed emotion in parent’s face creates more impression than verbal suggestions. Even a tight clenching of the child’s hand in dental office while undergoing dental treatment creates fear in child’s mind about dental treatment. IMAGINATIVE FEARS as the child’s imaginative capability develop, they become more intense with age.

23. Value of fear Fear lowers the threshold of pain so that every pain produced during the dental treatment becomes magnified. Since fear producing stimuli can cause actual harm to the child, fear is protective mechanism for self protection . The nature of fear can be utilizes to keep the child away from dangerous situation of either social or physical nature . The child should be taught that dental office is not a place to fear. Dentistry should not be employed as a threat or punishment using it in this manner creates fear of dentistry or dentist. On the other hand, if the child has become attached to the dentist, fear of loss of his approval may have some value in motivating the child for dental treatment.

24. FEAR EVOKING DENTAL SITUATION 26

25. Factors causing dental fear

26. SYPTOMS OF INTENSE FEAR Unpleasant feeling of terror Pounding of the heart Tense muscle Liability to startle Dryness of throat and Mouth Sinking feeling Nausia feeling Urge to urinate Irritability Anger Weakness Sense of unreality

27. Behavioral treatment of fearful children Communication Euphemisms The guidance cooperation model Time-structuring Distraction Guided imagery Behavior modification Parent in operatory

28. AN X IETY Is an emotion similar to fear but arising without any objective source of danger. Is a reaction to unknown danger. It is a learned process being in response to one’s environment. As an anxiety depends on the ability to imagine, it develops later than fear.

29. TYPES OF ANXIETY Trait anxiety It is life-long pattern of anxiety as a temperament feature. These children are generally jittery, skittish, and hypersensitive to stimuli. State anxiety These are acute situational-bound episode of anxiety that do not persist beyond the provoking situation. Examples: A child feels anxious when confronted by a large, strange animal. A person feels anxious to get on an airplane for the first time .

30. Free floating anxiety: It is condition of persistently anxious mood in which the cause of emotion is unknown and many other thoughts or event trigger the anxiety. Situational anxiety: It is only seen in specific situations or objects. General anxiety: where the individual experiences a chronic pervasive feeling of anxiousness, whatever may be the external circumstances.

31. CAUSE OF ANXIETY Uncertainty Fear of unknown is anxiety provoking. In dental clinic new patient’s anxiety can be due to uncertainty they feel about what await them after initial first appointment check up. Previous learning anxiety is present due to their previous learning experiences of trauma during the first visit or the learning involved in dental anxiety may have been more indirect, depending upon the experience of other people. Maternal anxiety directly relates to child’s anxiety . A mother with higher anxiety will have a child usually showing a negative behavior as a result of his/her high level of anxiety. Biological difference: Some people are more predisposed to become more anxious or to learn about anxiety responses than other due to the innate biological mechanism.

32. Dental anxiety and its implications for paediatric dentists With regard to paediatric dentistry, it is important to keep in mind that anxious patients manifest their anxiety in different ways. Some can respond with disruptive or interruptive behavior. Others can respond by sweating and an increased heart rate, whereas other patients do not show any external sign of anxiety

33. Dental anxiety, and the avoidance of situations that involve dental treatment and care, have frequently been considered to be the source of serious oral health problems in children and adults. High levels of anxiety prevent a patient from cooperating fully with their dentist, most importantly, can limit the effectiveness of the dental treatment and prevent the early detection of pathological processes

34. Methods of assessing dental anxiety

35. PH O BIA Is an ir rational fear resulting in the conscious avoidance of a specific feared object, activity or situation. It may be defined as a persistent, excessive, unreasonable fear of a specific object, activity or situation that results in a compelling desire to avoid the dreaded object.

36. Characteristics of phobia Being out of proportion to the stimulus or situation Cannot be reasoned with Being out of voluntary control Persistent and inadaptable. Shelhan (1982) divided anxiety and phobia into two major group: 1 endogenous 2. exogenous ( non – endogenous )

37. Non-endogenous (exogenous) This is a psychologically affected group which involves situation related anticipatory anxiety symptoms such as : Moist palms Fluttery stomach Fine hand tremor Shaky inside Rapid hart beat

38. These are the symptoms seen when normal individuals are arrested or threatened. the main cause is in the external environment It is an anxiety or phobia due to a factor “to be produced from the outside”. Thus, the individual can readily identify the etiological agent.

39. Endogenous: This anxiety is present without prior warning or the presence of ay detectable stress situation. The cause is “to be produced from within”. This type of anxiety has a more severe cluster of symptoms such as: Light headedness or dizziness Difficulty in breathing Parasthesia Hyper ventilation Chest pain Losing control

40. Acrophobia – height Agoraphobia – open space Arachnophobia – spider Anthrophobia – people aquaphobia – water Astraphobia – lightening Claustrophobia – closed space Cynophobia – dog Zoophobia – Animals Nyclophobia – darkness Pyrophobia - fire Xenophobia – stranger SIMPLE PHOBIAS Isolated fear of a single object or situation leading to avoidance of the object or the situation. The fear is irrational and excessive, but not always disabling.

41. SITUATIONAL PHOBIA Is popularly interpreted as a fear of open space, but has wider implication. It usually refers to a cluster of complaints. In addition to open or crowded places they also fear public transport, bridges, tunnels, benign alone at home or being away from home etc. Characteristics Dizziness, loss of bladder control or bowel control, cardiac distress. SOCIAL PHOBIA It is basically phobia due to the fear of being looked at and the concern about appearing shameful or stupid presence of other Main types of social phobia are public speaking, fear of eating, fear of blushing.

42. Phobia in childhood: The most common phobia in childhood is the fear of animal. This usually comes on between the age of 2 and 4 and is gone before the age of 10 years. Another common phobia is of darkness, a fear experienced b y children between the age of 4 and 6 years. This is most likely due to the imagination of the child as to various creature lurking out in the dark. School phobia is an exaggerated fear of attending school and occurs in all children peaking around 1 1 -12 years. A fear of the various activities connected to school such as new faces and challenges, fear of leaving home. In 12 years children of both sexes, previous aversive dental experiences are more closely related to dental phobia than general fear. At adolescent period most children outgrow their fear. Two phobias commonly seen are fear of blushing and fear of being looked at.

43. VIDEO LINK https://www.youtube.com/watch?v=pXqwWvzNykE https://www.youtube.com/watch?v=VXf7Wy1mYlU

44. CONCLUSION Dentally anxious/fearful children present a considerable challenge to parents, dentists and initial identification of such children is important in order to shorten involvement time, to allow the dentist to acknowledge their limitations, and to avoid frustration for the dentist and the patient. Uncooperative children have a special need, or a disability that requires proper knowledge and special attention during treatment.

45. REFERENCES: Dentistry for child and adolescent - Ralph E Mc Donald Text book of Pediatric Dentistry - S.G.Damle Text book of Pedodontics - Shobha Tandon Text book of Pediatric Dentistry - Nikhil Marwah

46. SUGGESTED READING Pediatric Dentistry: Infancy Through Adolescence (6 th Edition): Arthur J. Nowak Text book of Pedodontics - Shobha Tandon

47. University Questions Short note on 1. Fear - September 2012 (03 marks) Suggested Questions Short note on Phobias Types of Cry

48. MCQs Which of the following is not seen in infancy Distress Anxiety Startle response Delight Loud pitched noise in which the child throws temper tantrum with a siren like wail, this is : Obstinate cry Frightened cry Hurt cry Compensatory cry Reaction to unknown danger is Fear Anxiety Both of the above None of the above Causes of anxiety are: Uncertainty Previous learning Biological differences None of the above