This document discusses emotional development in children and focuses on common emotions seen in pediatric dentistry like cry, anger, fear, and anxiety. It describes characteristics of these emotions at different developmental stages. Assessment tools for measuring dental anxiety and fear are also outlined, including Venham's Picture Test, Facial Image Scale, and various questionnaires. The conclusion emphasizes the importance of responsive caregiving and enriching environments in facilitating healthy emotional development in children.

1. EMOTIONAL DEVELOPMENT
PRESENTED BY- DR.NAUSHEEN KHAN
MDS 1ST YEAR
BATCH 2017-18
DEPARTMENT OF PAEDODONTICS
&
PREVENTIVE DENTISTRY
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2. “Although the operative dentistry may be perfect, the
appointment is a failure if the child departs in tears”
Mc Elory (1895)
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3. CONTENTS
1. INTRODUCTION
2. CRY
3. ANGER
4. FEAR
5. ANXIETY
6. ANXIETY SCALES
7. FEAR ASSESSMENTS
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4. EMOTION
• It is a state of mental excitement characterized by physiological,
behavioral changes and alterations of feelings.
Emotional expressiveness through bodily movements,facial
expressions vocalizations are within a human being , reported to be
present in an infant through maturity.
INTRODUCTION
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5. Different Emotions At Different Stages Of Life
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6. Physiology Of Emotion
• Development of emotions depends on maturation in the nervous
system and the endocrinal system.
• Differences in emotional responsiveness between children and adults
appear to be partly due to cortical immaturity and partly due to
difference in endocrine output.
• At birth cortex development is completed , frontal lobe is immature
and has little influence on the functions of the lower parts of the
brain resulting in unbalanced emotions. Hence, emotional response
of the child is quickly aroused but short lived.
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7. • In 2 to 5 and 11 years adrenal glands gain weight rapidly and liberation of
adrenaline in blood is vigorous , as a result of which a preschooler is highly
emotional and emotional outbursts are prolonged too, giving rise to
physiological signs of emotional disturbance.
• As emotion subsides, parasympathetic energy – conserving system takes
over and returns the organization to normal.
• Activities of the brain in certain regions, including hypothalamus and other
parts of nervous system, directly influence muscles and internal organs to
initiate body changes.
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8. • Indirectly stimulating adrenal hormones to other body changes and
preparing the body for flight or fight response.
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9. Characteristics Of Commonly Seen Emotions In Child
DISTRESS OR CRY
At birth: Primary emotion present at birth with vigorous body
expressions usually due to hunger , colic or any other internal cause.
At six months: it is greatly replaced by a milder expression of fussing or
vocalization.
During preschool: it is seen less , only for the reasons of physical pain
as he is thwarted by his environment.
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10. • During school years: Pressure helps him to outgrow the crying habit
which decreases rapidly . After this till 15 years crying occurs very
seldom.
• In young adult: ultimately it becomes a limited quiet crying in private
only for reasons of grief or other intense emotions.
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11. Different Types Of Cries Seen In Children
Elsbach in 1963 has described four types of children's cries.
1. The obstinate cry
2. The frightened cry
3. The hurt cry
4. The compensatory cry
OBSTINATE CRY:
• made by an obstinate child.
• characterized by loud crying
• temper tantrum - kicking, biting etc
OBSINATE CRY
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12. FRIGHTENED CRY:
•Profuse tears & constant wailing sound.
•Crying due to fear
•confidence is lacking, not the discipline.
HURT CRY:
•Tears are the only manifestation.
•Simply reacting to stimulus of pain
•Making a valiant attempt to cooperate at the expense of his own
comfort
FRIGHTENED CRY
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13. COMPENSATORY CRY:
Not really a cry at all.
Sound that the pt. makes with drill, when the drill stops the cry stops.
no tears, no sobs-- just a constant whining noise.
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14. ANGER
• Outburst of the emotion is caused by the child’s
lack of skill in handling the situation.
• Infants and young children respond in anger in a direct and primitive manner but
as they develop , the responses become violent and more symbolic, for example-
• 15- months children express anger by throwing objects.
• Two-year-olds attack other children with an intention to hurt.
• Four year olds express their anger through begging.
• Five year olds , have less expression of anger.
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15. • Six year olds have a renewal of violent methods of expression of
anger.
• Seven year olds display less aggressiveness , through kicking ,
throwing observed.
• Eight to nine year old’s anger is expressed through feelings.
It directed towards a single person.
• 10 years old’s anger may become violent and may be expressed
physically.
• 12 years olds express anger verbally.
• 14 years olds may take out his anger on someone else.
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16. FEAR
Sydney Finn --“It is primary emotion acquired soon after birth".
Fischer – “fear is an emotion occurring in situations of stress and
uncertainty where in the person experiencing it sees himself as
threatened or helpless and whose reaction is to resist or flee the
situation out of anticipation of pain, distress, or distraction ”
Types:
• Objective fear
• Subjective fear
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17. OBJECTIVE FEAR
•Produced by direct physical stimulation of the sense organs.
•Not of parental origin.
Eg: unpleasant nature of past dental experience.
•May be associated with unrelated experiences.
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• Lowers the threshold of pain
• Smell of certain drugs or chemicals

18. SUBJECTIVE FEAR:
• Are those based on feelings and attitudes that have been suggested
to the child by others without the child having had the experience
personally .
• A young child is prone to suggestion.
• Shoban and Borland --- fear of dentistry in children was based more
on what they heard about dentistry from their parents than on
anything else.
• In children, the greatest producer of fear : hearing of unpleasant
dental experience from parents or friends.
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19. Two sub types of subjective fear-
1.Suggestive
2.Imaginative
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20. Suggestive fears :
• May be acquired by imitation.
• Generally recurrent fears ,more deep seated and difficult to eradicate.
• Acquired from friends or from materials --- books, periodicals,
cartoons, radio, television
• Fearful child is fearful of everyone and every thing.
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21. Imaginary fear:
Imagines fearful things & gets feared.
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22. Value Of Fear
• Fear has safety value when given proper direction and control.
• Since fear producing stimuli can cause actual harm to the child ,fear
is a protective mechanism for self protection.
• The nature of fear can be utilized to keep the child away from
dangerous situation of either social or physical nature.
• If child doesnot fear punishment or parental disfavor , his behavior
may make him a threat to society.
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23. • The child should be taught that dental office is not a place to fear.
• Dentistry should not be employed as a threat or punishment.
• If the child become attached to the dentist, fear of loss of his approval
may have some value in motivating the child for dental treatment.
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24. Fear Evoking Dental Stimuli
• Various dental stimuli evoke fear. It is observed that the most feared
events in the dental clinic can be ranked as:
• Anesthetic administration locally by injection
• Extraction
• Sound of drill
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25. Factors Causing Dental Fears
An interaction of various factors occurs in the existence of dental fear
such as :
• Fear of pain or its anticipation
• lack of trust or fear of betrayal
• fear of loss of control
• fear of the unknown
• fear of intrusion 25

26. Symptoms Of Intense Fear
• Unpleasant feeling of terror
• An urge to cry or hide
• Pounding of the heart
• Tense muscles
• Liability to startle
• Dryness of the throat and mouth
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27. • Stinking feeling
• Nauseous feeling
• Urge to urinate (very common in children)
• Irritability
• Anger
• Weakness
• Sense of unreality
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28. Physiological Signs Of Fear
• Pale sweaty skin
• Hair standing on end
• Dilatation of pupil
• Rapid breathing
• Increased heart rate
• Rising blood pressure
• Increased blood flow through muscles
• Contraction of the bladder and the rectum 28

29. ANXIETY
It is an emotion similar to fear but arising without any objective source of
danger.
It develops later than fear.
2 types of measurement technique :
• Techniques that rely on the observation of reactions of child by others.
Eg: behavioral & physiological measurements
• Techniques that rely on some form of verbal – cognitive self report.
Eg: questionnaires.
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30. • Self report instrument using a picture technique for answering
• Measure of the change in dental anxiety as a consequence of presence /
absence of parent in the dental treatment.
• Consists of 8 items measuring situational / state of anxiety
• 8 pictures of children , exhibiting various emotions
• Child’s the best reflects his own
• scores = 0-8
• Easy to administer
• Best suited for the children
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31. There Are Following Dental Anxiety Scale-
1. Corah’s dental anxiety scale
2. Dental anxiety question
3. Modified dental anxiety scale
4. State-trait inventory
5. Venham’s pictures test
6. Facial image scale
7. Smiley faces program
8. Anxiety thermometer
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32. Most commonly used dental anxiety scales are-
• Venham’s picture test
• Anxiety rating scale
• Facial image scale
• Smiley faces program
• Anxiety thermometer
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33. Vanham Picture Test
• This scale consists of a series of eight paired
drawings of a child.
• Each pair consists of a child in a nonfearful pose
and a fearful pose.
• The respondent is asked to indicate , for each pair,
which picture more accurately reflects his or her
feelings at the time.
• Scores are determined by summing the number of
instances in which the child selects the high fear
stimulus. 33

34. Facial Image Scale
• This scale has a row of five faces ranging from very happy to very
unhappy.
• Children are asked to point at which face they felt most like at the moment.
• The face is scored by giving a value of one for the most positive face and
five for the most negative face.
• Faces four and five indicate high dental anxiety.
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35. Smiley Faces Program
• Buchanan, using multimedia tool book , developed an interactive
computerized version of the Facial Image Scales and the windows program
was entitled Smiley Faces.
• This is a fully computerized scale where the child must select from a range
of seven facial expressions indicating how they feel.
• The questions appear on the computer screen for matter of seconds and then
the child is asked to replace the neutral face with one of seven faces which
describe how they feel about the dental procedures.
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36. Anxiety Thermometer
This is an image of a thermometer where
the respondent selects a point on the
thermometer to rate anxiety 0 = no anxiety
and 10 = extreme anxiety
Anxiety thermometer 36

37. • This scale gives 5 options graded 0 to 4 ,
from relaxed to panic behavior depicted by
different pictures.
0 – relaxed
1 - uneasy
2 - feeling scared but cooperative
3 - feeling scared and uncooperative
4 - feeling very scared , uncooperative ,
requires physical restraints.
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Anxiety Rating Scale

38. The child is shown pictures and encouraged to represent his or her
feelings.
• VERBAL QUESTIONS
The child is asked questions or given “sentence completion tasks” to
verbalize his fear.
Negative or reluctant answers imply fear while positive opinions implies
non-fearful child.
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39. QUESTIONNAIRE
• Anxiety can also be evaluated by answers to the questions given to
the child patient and the parent.
• The questions help to determine the attitude and experiences of both
the patient and parent.
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40. PHOBIA
• It is an irrational 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.
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41. Characteristics Of Phobia
• Being out of proportion to the stimulus or situation.
• Being out of voluntary control
• Persistant and inadaptable
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42. Types Of Phobia
Shelhan (1982) divided anxiety and phobia into two major groups:
1- Exogenous
2- Endogenous
Exogenous-
This is a psychologically affected group which involves situation related
anticipatory anxiety symptoms such as:
• Moist palms
• Fluttery stomach
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43. • Fine hand tremors
• Shaky inside
• Rapid heart beat
These are the symptoms seen when normal individuals are stressed 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.
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44. Endogenous
• This anxiety is present without any prior warning or the presence of any
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 44

45. Phobia In Childhood
• The most common phobia in childhood is the fear of animals. This usually
comes on between the age of 2 and 4 years and is gone before the age of 10
years.
• Another common phobia is of darkness , a fear experienced by children
between the age of four and six years.
This is most likely due to imagination of child as to various creatures lurking
out in the dark.
School phobia is an exaggerated fear of attending school and occurs in all
children peaking around 11-12 years.
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46. • 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 looked at.
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47. Fear Assessments
The Children’s dental fear picture test (Klingberg,1994)
The children’s dental fear picture test (CDFP) consists of three different
subtests-
• The dental setting pictures (CDFP-DS)
• The pointing pictures (CDFP-PP)
• A sentence completion task(CDFP-SC)
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48. • The dental setting pictures contain a set of ten pictures of animals in
different progressively more stress evoking dental care situations.
• The pictures are presented to the child in numerical order and the
child is encouraged to tell a story about each picture.
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49. • The pointing pictures contain a set of five pictures showing a human
child in five different dental related situations-
1. Just before going to dentist
2. The dentist examining the mouth
3. The dentist giving an injection
4. The dentist drilling
5. Lying in bed about to fall asleep or dreaming about dentists.
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50. Each card shows two different reactions:
• One happy
• Non fearful child
• One sad
• Fearful child
 Four rings of different sizes are situated below each picture, representing
four different feelings or answers to the pictures: very happy and not the
least afraid : feeling very much afraid: feeling somewhat afraid: feeling very
much afraid.
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51. • Answers are given verbally as well as by pointing to the ring
representing the child’s choice.
• The answers represent scores ranging from 1(very happy and not the
least afraid) to 4 (very much afraid).
• Thus, the test give a possible score ranging from 5 to 20
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52. • The sentence completion tasks contains 15 incomplete sentences ,
which are given to the child to read consecutively.
• The child is instructed to complete the sentences by saying the first
word or words that come to mind.
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53. CONCLUSION
The young brain develops rapidly , with the potential for remarkable
growth but also vulnerability to harm and stress.
Responsive caregiving , high quality learning environments rich in
language and interactions with peers will scaffold a child through stages
of emotional development.
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54. REFERENCES
1. N.MARWAH.”Psychometric assessment of dental fear and
anxiety.”Textbook of Pediatric Dentistry.3rd edition:Jaypee Brothers
medical publishers;2014.P212-218
2. S.TONDON.”Emotional Development.”Textbook of Pedodontics.2nd
edition:Paras medical publishers;2009.P134-141
3. N.MARWAH.”Fear and anxiety.”Textbook of Pediatric Dentistry.3rd
edition:Jaypee Brothers Medical publishers;2014.P 205-210
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