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The Ethical Dilemma of Pediatric Dental Restraint

On May 18, a report by CBS News out of Boston WBX-TV brought to light a dilemma for pediatric dentists and parents that has been controversially debated for several years, yet has not gotten much mainstream press attention. Dr. Stephen Hill offers pediatric sedation dentistry as a safe alternative to the controversial papoose board.

Often children are nervous, impatient, and have difficulty sitting still throughout the length of a routine dental procedure. Unfortunately, for child and dentist alike, the wrong squirmy movement can potentially jerk the dentist’s hand causing unintended abrasion, cuts or other trauma to the child’s mouth. Since 2004, some pediatric dentists have adopted the use of the papoose board, a restraint device commonly used in emergency medicine for agitated children, adolescents and patients with special needs.

The papoose board was developed based on the idea of the Native American swaddling technique and is designed to provide gentle restraint and theoretically womb-like sense of security. It has a head strap to secure the position of the head and three segments that can be wrapped around the shoulders and arms, torso, and legs.  It has armholes so the dentist using the restraint can leave one or both arms free to signal if the child has a question or a problem. The goal of the device is to keep the child still to prevent unnecessary injury during care.

Over the last few years, parents and child psychologists have been strongly divided over the use of swaddling techniques and the potential effects on a child’s mental health.  It became a hot topic when a mother burst into a dentist’s office to find her child restrained without her consent. Some believe swaddling devices are calming and safe, while others claim that restraining a child’s movements can be abusive and damaging to the child’s mental health. While the devices are FDA approved, several US states have passed laws banned daycares and childcare professionals from swaddling children. From a legislative perspective, the US remains a country divided on this topic.

The American Association of Pediatric Dentists published standards in 2013 that suggest that papoose boards should mainly be used in emergency situations and that other alternative measures, such as bringing the parent into the room, and use of nitrous oxide sedation prior to resorting to the use of restraint. They also included in their guidelines that papoose boards should only be used with parental consent.

With Dr. Stephen Hill, you can rest assured that your child will receive care in accordance with your wishes and applicable American Pediatric Dental Association guidelines. To learn more about pediatric sedation dentistry and techniques to calm your child during dental procedures or schedule an appointment, contact our office at 469-617-6488 And if you comment on the use of papoose boards in pediatric care, we’d love your thoughts, so submit your comments on our site.

Call Hill Dental Studio today at 469-617-6488.

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