How Do Observational Scales Correlate the Ratings of Children’s Behavior during Pediatric Procedural Sedation?

Table 3

Venham Behavior Rating Scale [23, 26].

Score	Behavior	Description	Brazilian version (free back translation to English)
0	Total cooperation	Best possible working conditions, no crying or physical protest.	Score 0, no protest: the child has no physical protest, such as crying or body movements that disturb the dentist, enabling good working conditions.
1	Mild protest	Soft verbal protest or (quiet) crying as a signal of discomfort, but not obstructing progress. Appropriate behavior for procedure, that is, slight start at injection, “ow” during drilling if hurting, and so on.	Score 1, mild protest: the child protests quietly (grumbling) or contained crying as a sign of discomfort. However, it does not prevent the continuation of treatment.
2	Protest more prominent	Both crying and hand signals. May move hands around making it hard to administer treatment. Protest is more distracting and troublesome. However, child still complies with request to cooperate.	Score 2, intense protest: the child expresses discomfort verbally with strong crying and body movements (hands, arms, heads, etc.) that interfere with the performance of the procedure. However, he or she still meets the requests to cooperate, even if with some resistance.
3	Protest presents real problem to dentist	Complies with demands reluctantly, requiring extra effort by dentist. Body movement.
4	Protest disrupts procedure	Requires that all of the dentist’s attention be directed toward the child’s behavior. Compliance is eventually achieved after considerable effort by the dentist, but without much actual physical restraint (may require holding child’s hands, or the like, to start). More prominent body movement.	Score 3, more intense protest: the child makes larger body movements, including trunk and legs. The procedure can be stopped, representing a real problem for the dentist and demanding physical and mental effort. Physical restraint is required for part of the body (hands, head). Yet the child cooperates reluctantly and partially with the dentist’s commands.
5	General protest	No compliance or cooperation. Physical restraint is required.	Score 4, general protest: no cooperation from the child. The situation results in physical and mental stress for both the child and the dentist. Physical restraint (hold, arms, legs, head, etc.) is required, the child may try to escape from the chair and cover the mouth, and sometimes the conclusion of the procedure becomes impossible in one session.