Parental Presence and Preschoolers' Behavior
Condition: Parent-Child Relations; Dental Fear
Study type: Interventional

Summary: 
      Purpose: This study aimed to assess the effect of parental active/passive presence technique
      (PAP/PPP) on the overall behavior of preschool children with different intelligence and fear
      levels.

      Methods: This randomized controlled trial recruited 150 healthy children, 3-6 years old, with
      no history of previous dental pain/treatment, IQ level ≤70 to ≤110. After sample collection,
      in the first visit, children were stratified according to their Intelligence Quotient into 3
      equal groups (high, average, low) in which each group was further equally and randomly
      divided into 2 sub-groups (test and control). In the second visit, before intervention with
      preventive measures, dental fear was assessed using facial image scale. During intervention,
      the control sub-groups were managed using PPP technique, while the test sub-groups were
      managed using PAP technique. Overall behavior was assessed using Frankl behavior rating scale
      at the end of the 2nd visit. Data was analyzed using chi-square test and logistic regression
      analysis.

      Results: The PAP technique had significantly higher odds of positive behavior than the PPP
      technique (P=0.002).

      Conclusions: Children with low intelligence showed higher dental fear and negative behavior
      in the dental setting. PAP technique had significant positive effect on the children's
      overall behavior with different fear and intelligence levels.
    

Detailed description: 
      The design of the study was a randomized controlled clinical trial with an allocation ratio
      of 1:1. Children enrolled in this study were stratified based on their IQ into three groups;
      high, average and low IQ groups. In each of these three groups, children were randomly and
      equally allocated into study and control subgroups. Thus, this study included 6 subgroups.

      - Visual Screening and History taking were carried out to identify children who fulfilled the
      inclusion criteria. Parental meeting was also conducted to explain the child entire research
      plan.

      The children were recruited from the Outpatient clinic of Pediatric Dentistry Department in
      Faculty of Dentistry at Alexandria University.

      The IQ test for each selected child took place in a quiet closed room (special need clinic).
      The preventive measures were applied in the pediatric clinic of the department.

      - Interventions

      In the first visit, children who fulfilled the inclusion/ exclusion criteria were evaluated
      by IQ test then divided into 3 equal groups (50 children) according to their level of
      intelligence IQ as follows:

        1. High IQ Children group (HIQ): with score of (110 and above)

        2. Average IQ Children (AIQ): with score of (90-109)

        3. Low IQ Children (LIQ)(with the normal intelligence range): with score of (70-89) In the
           second visit, fear was measured in each group followed by random allocation into test
           and control subgroups and then the implementation of the intervention.

             -  In each group (50 children), 25 children in subgroup S (study group) were managed
                using Parental Active Presence (PAP) technique, while the other 25 children in
                subgroup C (control group) were managed using Parental Passive Presence (PPP)
                technique. Parental Active / Passive Presence technique was accompanied with
                Tell-Show-Do (TSD) Technique (Addelston, 1959). During this management, dental
                preventive measures were applied.
    

Intervention name(s): Parental active presence; Parent passive presence
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The parents were allowed to stand close to their children, do handholding, eye contacting and help in explaining the dentist's instructions.; Parents were instructed to sit silently in the dental clinic behind the patient with no eye contact, and without a spoken word only to reassure their children
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: Dental fear; Intelligence quotient; Preschool children; Parental technique; Behavior modification