The Papoose Board and mothers' attitudes following its use

Resident: Roberts
Date: 9/18/09
Article title: The Papoose Board and Mothers Attitudes Following its Use
Journal: Pediatric Dentistry:
Volume 13 number 5; pages 284-287
Year: 1991
Introduction:
Sedation, tell – show – do, voice control, and positive reinforcement are techniques employed by pediatric dentist in order to obtain cooperation by their patients. In some circumstances these techniques do not work sufficiently. When dentistry is imperative and these techniques are unsuccessful, sometimes physical restraint must be used in order to get the job done. Studies conducted in the early 1980’s report that upto 86% of pediatric dentist used papoose boards as a behavior management technique in their office. Upto 53% of pediatric dentist in past surveys have reported preferring this technique to sedation methods. In a study performed by Fields in 1984, this technique was determined to be the least favorable method to obtain cooperation of patients by their parents.
In this article a study was conducted in a Midwest city, in a suburban pediatric dental practice where subjects could be drawn from Caucasian, Asian-american, African –american and families of all socioeconomic status. The goal was to reevaluate patient and parent acceptance using the papoose board as a method of behavior management in the dental office.
Techniques:
First appointment consisted of an initial exam without the PB in order to develop a tentative treatment plan. Second appointment consisted of an Indian game to entice the child into the papoose board and an astronaut game that allowed the child to be fitted for nitrous oxide comfortably. The mother was allowed to stay in the room during the appointment holding her child’s one hand that was not securely fastened within the PB. All other aspects of the appointment remained consistent with routine operative care.
Survey and results:
Seventy four children were treated while securely fastened to a PB. Their mothers were issued surveys at the end of the appointment which could be mailed back anonymously. Of the original 74 only 59 were mailed back.
Take home message:
66% of mothers indicated that using a PB was stressful for their child
96% of mothers said the PB was necessary in order for the dentist to do his job
90% realized that immobilizing their children protected them from harming themselves
70% felt that their children were comfortable despite the stress of the appointment
60% did not rate their children as being more afraid of the dentist after being papoosed
68% did not report negative effects after the treatment
86% would be willing to have their next child treated with the PB

Conclusion: Implementing the PB as a behavior management technique is an effective method of dealing with difficult patients. Unlike previous studies, this study found that parent acceptance of the method was favorable. The conclusion was that proper presentation to the parent and child must be performed prior to and during treatment. Allowing the mothers to participate in the treatment by holding their childs hand seemed to have a positive effect on their perspective of this treatment and its outcome. It was recommended that pediatric dentist keep the PB as part of their armamentarium in dealing with patient behavior in the office.

Assesment: good article - makes sense