Parental Presence vs Absence - Dr. Julie Maniate
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Transcript of Parental Presence vs Absence - Dr. Julie Maniate
Parental Presence/Absence
During the Treatment of a
Pediatric Dental Patient
Julie Maniate DMD, FRCD(C), ABPD
November 7, 2010
Dental Fear
• Handicapping complication, stress
1. Determine prevalence
2. Tools to diagnose presence & severity
3. Tools to measure treatment need &
success of therapy1
Behavioural Rating Scale
Frankl Scale (1962)1
1. Definitely Negative: Child completely uncooperative,
crying, very difficult to make progress
2. Negative: Child uncooperative, very reluctant to
listen/respond to Qs, some progress possible
3. Positive: Child cooperative, somewhat reluctant/shy
4. Definitely Positive: Child completely cooperative and even
enjoys the experience
History
Focus: parent presence in operatory
• 18982:
parents be excluded
• 19583:
parent presence/absence did not affect patient‟s response
History
• 19624:
age 41-49 mths: most negative behaviour
when separated
Age 50-66mths: no significant differences in
behaviour
History
Focus: relationship b/w level of parental
anxiety and patient behaviour
• 19835: 75% responding dentists restricted
parents from operatory
• Dental schools: taught exclusion of
parents
For Exclusion
1. Parent distracts
2. Parental anxiety
3. Uncomfortable for practitioner
For Exclusion
• Psychological journals6-9
Parent-child separation issue
Found: presence of parent has favorable effect on children
child feeling of security and improved coping behaviour
Conclusions contrast sharply with
dental literature.
For Exclusion
Question:
Could the separation itself have caused the
undesirable behavioural changes?
For Exclusion
• 197710:
Study of behavioural effect of parental
presence & absence over series of appts
N=98
2 groups: “parent present” or “parent absent”
Group category switched for 2nd appt
Conclusion: no significant differences
For Exclusion
• 197811:
Study of behavioural effect of parental
presence & absence over series of appts
Allowed parent & child to choose group
Conclusion: parent presence resulted in
children being more relaxed
For Exclusion
• 198212:
Parent-child separation randomly assigned
Conclusion: no significant difference
For Exclusion
• 199313:
No significant difference between patients
separated from parents and those who
remained for treatment
Slight increased frequency of negative
behaviour in separated group
For Inclusion
1. Studies show no significant difference in
patient behaviour
2. Separation can increase stress
3. Parents‟ concerns can be alleviated
4. Opportunity for parent to witness child‟s actual
behaviour14
For Inclusion
Child
Dentist Parent
For Inclusion
• Association for the Care of Children‟s
Health (ACCH)15
Advocate/promote parental involvement in
health care setting
• Pediatric medical practice
Parents rarely excluded from observing &
participating in care of child
For Inclusion
• 198916:
Surveyed pediatric dentists:
60%: parent welcome for initial exam
34%: allow parent during treatment visits
Increasing (slight) trend toward accepting and
inviting parents to be present.
Still no general consensus.
For Inclusion
Child
Dentist Parent
Practitioner Attitude/Perception
• Good behavioural management
techniques essential
• Good rapport between dentist and child
shown to influence success of treatment
Practitioner Attitude/Perception
• 2002 (Crossley & Joshi)17:
Survey: 245 pediatric dentists
Attitudes toward parental accompaniment
Attitudes regarding parental expectations
Attitudes toward use of different child mgmt techniques
Results/Conclusion
80% supported parental accompaniment
Minority felt pressured by parental expectations
87% favoured “tell-show-do” method of beh. mgmt.
Parents’ Attitude/Perception
• 1998 (Peretz & Zadik)18:
Survey: 104 adults Sociodemographic information
Parent preference re. staying with child
Willingness to assist dentist
Results/Conclusion: No sociodemographic variable
70% expressed wish to be present in operatory
58% willing to assist dentist
Parental Presence/Absence
(PPA) Technique
• 2009 (Kotsanos et al.)19:
Prospective study: 33 mths 440 children, ages 3 to 10
Frankl 1 or 2 behaviour--offered parental presence only if cooperative/parent stepped out until behaviour improved
Results/Conclusion: 93% responded to PPA technique by displaying
positive behaviour as first visit progressed
All children cooperated in subsequent appts
Summary
• Parent:
be with children in operatory during dental
treatment, assist when needed
• Dentist:
develop strategies that include parent
Possible Strategies
1. Est. office policy that invites/encourages parent
2. Train office staff
3. Place an “observation chair”
4. Learn to talk with both child & parent
5. Discuss behaviour mgmt techniques with parents
6. Establish rules of conduct for parent
• “silent observer”
Conclusion
“Including the parent in the operatory can be
a very rewarding experience for the dentist
who treats children,
and can help build trust and understanding
with the families of our children.”20
References
1. Folyan MO, Kolawol KA. A critical appraisal of the use of tools for assessing dental fear in children. Afr J Oral H 2004; 1:54-63.
2. Belcher D. Exclusion of parents form the operating room. Brit J Dent Sci 1898; 41:1117.
3. Lewis TN, Law BB. Investigation of certain autonomic responses of children to a specific dental stress. JADA 1958; 57:769-777.
4. Frankl S, Shiere F, Fogels H. Should the parent remain with the child in the dental operatory? J Dent Child, 2nd Quarter 1962;29:150-163.
5. Glasrud PH. Dentists‟ attitudes toward preschool patients. J Dent Res 1983; 62:234.
6. Shirley M, Poyntz L. The influence of separation from the mother on children‟s emotional responses. J Psychol 1941: 12:251-282.
7. Arsenian JM. Young children in an insecure situation. J Abn & Soc Psychol 1943; 38: 225-229.
8. Yarrow LJ. Separation from parents during early childhood. In Hoffmann ML and Hoffmann LW ed.: Review of child development research. Vol1, Russell Sage Foundation, New York 1964.
9. Amorso D, Walters RH. Effects of anxiety and socially mediated anxiety reduction on paired-associate learning. J Personal & Soc Psychol 1969; 11:388-396.
10. Venham LL, Bengston D, Cipes M. Pre-school child‟s response to sequential dental visits. J. Dent Res 1977; 56:454-459.
11. Venham LL Bengston D, Cipes M. Parent‟s presence and the child‟s response to dental stress. J Dent Child 1978; 45:213-217.
References
12. Pfefferle JC, Machen JB, Fields HW, Posnick Wr. Child behavior in the dental setting relative to
parental presence. Ped Dent 1982; 4:311-316.
13. Fenlon WL, Dobbs AR, Curzon MEJ. Parental presence during treatment of the child patient: A
study with british parents. Brit Dnet J 1993; 174:23-28.
14. Weinstein P, Nathan JE. The challenge of fearful and phobic children. Dent Clin North Amer 1988;
32:667-692.
15. ACCH: Position Statement on Involvement of Parents and Families in Health Care Settings.
Washington, DC, 1978.
16. Nathan JE. Management of the difficult child: A survey of pediatric dentists‟ use of restraints,
sedation and general anesthesia. J Dent Child 1989; 56:293-301.
17. Crossley ML, Joshi G. An investigation of paediatric dentists‟ attitudes toward parental
accompaniment and behavioural management techniques in the UK. Br Dent J 2002; 192:517-
521.
18. Peretz B, Zadik D. Attitudes of parents towards their presence in the operatory during dental
treatments to their children. J Clin Pediatr Dent 1998; 23:27-30.
19. Kotsanos N, Coolidge T, Velonis D, Arapostathis KN. A form of „parental presence/absence‟ (PPA)
technique for the child patient with dental behaviour management problems. Eur Arch Paediatr
Dent 2009; 10:90-2.
20. Certo MA, Bernat JE. Parents in the operatory. NY State Dent J 1995; 61:34-38.