A randomised crossover trial on caregivers’ perceived mannerisms and the physiological variations in behaviour guidance techniques for children with special health care needs during dental treatment / Norsaima Ismail

Exploring caregivers’ opinions regarding Papoose Board® (PB) in managing children with special health care needs (CSHCN) is critical upon identifying behaviour guidance application priorities. It is perceived that passive immobilisation with PB may cause physical distress and intense anxiety manifestations among children during dental treatment. This study aims (i) to compare the caregivers’ acceptance, consent, and concern towards the usage of Papoose Board® and a combination of tell-show-do (TSD), distraction (D), and positive reinforcement (PR) for their children with special health care needs; (ii) to evaluate caregiver’s attitude, acceptance, consent, and concern of Papoose Board® for children with special health care needs before and after dental treatment; iii) to assess the caregivers’ socioeconomic background, educational level, and previous dental experience on the usage attitude of Papoose Board® for their children with special health care needs, and; (iv) to investigate physiological variations in blood pressure, heart rate, and oxygen saturation level while utilising Papoose Board® and a combination of tell-show-do (TSD), distraction (D), and positive reinforcement (PR) on children with special health care needs. The registered crossover trial (ISRCTN57204958) involved 90 CSHCN who received standard dental care with two methods of behaviour guidance techniques sequentially, in which the exposure was randomised. Specifically, exposure A is a combination of basic behaviour guidance techniques (CBBGT), while exposure B is PB. Caregivers were required to complete a self-administered-paper-based questionnaire during pre- and post-intervention. The subject child’s blood pressure, heart rate, and oxygen saturation level were measured at four different times. As a result, it was found that 88 caregivers aged between 30-58 years old and their children aged between 2-15 years old completed the sequence. Following that, 98.9% of the children were diagnosed with neurodevelopmental disorders, and 1.1% had a physical disability. Wilcoxon Sign Rank Test revealed no statistical difference between CBBGT and PB paired scores median of caregivers’ acceptance (p = 0.081) and consent (p = 0.546), although a significant difference in concern was found (p = 0.045). The caregivers also showed a significant improvement in attitude (p < 0.001) toward the use of PB after observing the placement on their children. Moreover, physiological data revealed no significant changes when children were treated with PB or CBBGT. A comprehensive introduction of the passive immobilisation technique boosted caregivers’ mannerisms towards PB utilisation on their CSHCN during dental treatment. PB is considered safe and has no discernible influence on the child's physiological variation.