Enhancing pediatric health care with music

Auxiliary Aids to Alleviate Pain and Anxiety during Local Anesthesia Administration: A Comparative Study

Introduction

In dentistry, pain and anxiety have been the most challenging aspect in the management of a pediatric patient. When every effort to perform local anesthesia (LA) is not successful, the result would be more stressful for both the dentist and the patient. The so-called clichéd paradigm that “pain and dentistry are inseparable” can be resolved by updating the knowledge and skills of the practitioner by using the more advanced techniques in controlling and managing the pain. An array of techniques for administering the LA to improve the comfort level of our patients has been the area of interest.

Aim and objective

To evaluate and compare the efficacy of various adjunctive aids of LA in reducing pain and anxiety in pediatric patients of the 6–8 years age-group. A total of 90 child dental patients were selected and randomly divided into six groups, i.e., control, topical gel, audio, audiovisual, transcutaneous electric nerve stimulation (TENS), and Vibraject group. Physiological parameters, psychological parameters, and pain assessment were recorded.

Results

As reflected by the results, the minimum pulse rate “during” and “after” LA administration is seen in A/V (D) and TENS (E) “during” LA administration. Children were less anxious and more relaxed in the audiovisual group and TENS group. Transcutaneous electric nerve stimulation and Vibraject groups showed maximum reduction in pain.

Conclusion

A/V (D) and TENS (E) groups exhibited the least anxiety. Also, the minimum pain was felt using TENS (E) and Vibraject (F) and hence, may be considered as adjunctive aids in pain reduction during LA administration.

How to cite this article

Midha V, Midha V, Dua R, et al. Auxiliary Aids to Alleviate Pain and Anxiety during Local Anesthesia Administration: A Comparative Study. Int J Clin Pediatr Dent 2021;14(1):104–108.

Music interventions for dental anxiety

Anxiety is a significant issue in the dental care of adults and children. Dental anxiety often leads to avoidance of dental care which may result in significant deterioration of oral and dental health. Non-pharmacological anxiety management interventions such as music listening are increasingly used in dental care. Although efficacy for music's anxiolytic effects has been established for pre-operative anxiety, findings regarding the use of music listening for dental anxiety are inconclusive, especially for children. The use of music for passive distraction may not be adequate for children and highly anxious adults. Instead, interventions offered by a trained music therapist may be needed to optimize music's anxiolytic impact. Music therapy interventions are individualized to the patient's presenting needs and geared at enhancing patients' active engagement in the management of their anxiety. Interventions may include (i) active refocusing of attention, (ii) music-guided deep breathing, (iii) music-assisted relaxation, and (iv) music-guided imagery. In addition, music therapists can teach patients music-based anxiety management skills prior to dental treatments, offer them the opportunity to express emotions related to the upcoming procedure, and help them gain a sense of control and safety. Clinical guidelines for the use of music listening by dental practitioners are offered.

"A day in my life" photography project: the silent voice of pediatric bone marrow transplant patients

A photovoice project was conducted with pediatric bone marrow transplant (BMT) patients to examine their coping skills and interpretation of their experience during a BMT, especially when hospitalized. We also wanted to determine how photovoice could be used within a pediatric BMT unit. Sixteen children (ages 4-14) and 2 young adults (ages 22 and 25) from a pediatric BMT unit participated in the project. Six BMT outpatients participated in the data analysis and evaluation phase. Fourteen clinical staff evaluated the impact of the project on their practice. Three primary themes emerged from the pre- and post-BMT photos, accompanying detailed notes, and BMT outpatient analysis of the photos: (a) BMT is "torture," (b) BMT is "time slipping away," and (c) BMT requires normalization, comfort, distraction, and support. BMT patients and staff concluded that photovoice helped express and release emotions regarding the challenges of BMT. BMT staff noted that the results of this project reminded them of the importance of being patient-centered and mindful of patient experience and the therapeutic relationship.

Music as a therapy: role in psychiatry

Music is popularly believed to usher in bliss and serenity, and healing is considered its natural quality. It has an emotionally charging charisma of its own, that we all as listeners might have experienced at times. Music has been there with mankind since the beginning of history, but where does it stand as a therapy? Is there any evidence base? How this therapy came into being and how it has evolved, and what the old and current research says about its role in psychiatric disorders. This review tries to explore these questions and arrives at a conclusion that music certainly promises more than just entertainment, and evidence so far suggests music therapy can be beneficial in the treatment of psychiatric disorders, as a cost effective noninvasive adjunct to standard therapy in a variety of settings and patient groups, yet more validated scientific research is still required to establish it as a sole quantified therapy.

Exploring the needs and resources of children in a haematology-oncology unit

Too often a child’s body is restored to health in the hospital, but the child is sent home with emotional wounds. This study explored the needs of children in a haematology-oncology unit as well as the resources that could be mobilised in order to address these needs by firstly carrying out a literature review. A field study was then conducted in order to prioritise the resources according to their importance for children in a haematology-oncology unit. A definite trend could be found in the way that the children responded to the request to prioritise the resources. The first three resources, as chosen by the children, all concerned the external social environment of the child. It could therefore be concluded that support from parents and other people of significance are most important to the child and should be taken into account when facilitating support for children in a haematology-oncology unit. It could also be concluded that these children do not experience sufficient control in their situation and it could therefore be suggested that children in a haematology-oncology unit should experience more control and power in their situation.OpsommingSo dikwels word ‘n kind se liggaam genees in die hospitaal, maar hierdie selfde kind gaan huis toe met emosionele wonde. Die behoeftes van kinders in ‘n hematologie-onkologie eenheid is ondersoek asook die hulpbronne wat gemobiliseer kan word om hierdie behoeftes aan te spreek deur gebruik te maak van ‘n literatuurstudie. Daarna is ‘n veldstudie gedoen om hierdie hulpbronne te prioritiseer volgens die belangrikheid daarvan vir kinders in ‘n hematologieonkologie eenheid. Die manier waarop die kinders die hulpbronne geprioritiseer het, het ‘n definitiewe tendens getoon. Die eerste drie hulpbronne wat deur die kinders gekies is, is al drie hulpbronne wat die eksterne sosiale omgewing van die kind behels. Die gevolgtrekking kan dus gemaak word dat die ondersteuning van ouers en ander persone wat belangrik is vir die kind, van uiterste belang is en in aanmerking geneem behoort te word in die fasilitering van ondersteuning van kinders in ‘n hematologie-onkologie eenheid. Die gevolgtrekking wat gemaak kan word is dat hierdie kinders nie genoeg beheer ervaar in hulle situasie nie en daarom word voorgestel dat kinders in ‘n hematologie-onkologie eenheid meer bemagtig behoort te word gegewe hulle omstandighede.

Effectiveness of music interventions on dental anxiety in paediatric and adult patients: a systematic review

BACKGROUND

Dental anxiety has been identified as a significant and common problem in both children and adults and is considered an obstacle for dental care providers in the delivery of quality oral care. Patients with dental anxiety tend to avoid professional dental care which poses a problem for dentists and patients alike.There are various treatment options for reducing dental anxiety. Music has been used in different medical fields to meet physiological, psychological, and spiritual needs of patients. Music interventions can either be passive (music listening) or active music (therapy).There was a significant gap in the literature on the effectiveness of music therapy and music listening in reducing dental anxiety in patients undergoing various dental treatments/procedures. This systematic review specifically examined the effectiveness of music interventions in reducing dental anxiety in both paediatric and adult patients.

OBJECTIVE

The objective of this systematic review was to critically appraise, synthesise and present the best available evidence related to the effectiveness of music interventions on dental anxiety in paediatric and adult patients.

DATA SOURCES

A comprehensive search was undertaken on major electronic databases from their inception to October 2010. The search was restricted to English language and other languages where a translation was available from colleagues (for e.g. Chinese, Japanese, and Italian).

REVIEW METHODS

Randomised controlled trials, quasi-randomised controlled trials and quasi-experimental studies were included in the review. Critical appraisal and data extraction were undertaken using the Joanna Briggs Institute critical appraisal instrument and the standard data extraction form for evidence of effectiveness.

RESULTS

Seven studies with a combined total of 598 patients were included. Two out of the seven studies were RCTs, four quasi-randomised and one quasi-experimental study. There were 513 adult patients as participants from five studies and 85 paediatric patients from two studies. The results were classified into two categories.Two studies had paediatric patients as population group. One study found that music listening did not result in any reduction of anxiety during dental procedures on young patients; therefore the authors concluded that music alone is ineffective as a distraction during dental procedures. However, another study found that music reduced anxiety to some extent, although it was not significant.Five studies included in this review had adult patients as population group. Two studies concluded that relaxation when compared to music is an effective method of reducing patient's anxiety. One study concluded that music listening significantly lowered levels of anxiety and stress of females during dental procedures. Authors of the study concluded that there was a strong physiological (increased secretory immunoglobulins level) response to music by females. Two other studies provided conclusive evidence on effectiveness of music in reducing dental anxiety in this population group.

CONCLUSIONS

This systematic review concluded that there was enough evidence to suggest that adult patients may benefit from a procedural music-listening program. There was inconclusive evidence on the effectiveness of music in reducing dental anxiety in children.

IMPLICATIONS FOR PRACTICE

It is recommended that pre-recorded music be offered through headphones during the dental procedure to adult patients to reduce their dental anxiety. The evidence on the effectiveness of music in reducing dental anxiety in children is inconclusive.

IMPLICATIONS FOR RESEARCH

More research needs to be performed before it is possible to show, with a higher degree of certainty, that music listening does have a significant effect on the reduction of dental anxiety. Future studies, most likely randomised controlled trials should evaluate music therapy as an intervention for managing dental anxiety.

Use of music during physical therapy intervention for an infant with Erb's palsy: A single-subject design

Evidence supporting the use of music during pediatric physical therapy intervention is limited. The purpose of this single-subject design was to evaluate the effects of music on patient progress, the amount of crying during therapy, and parent satisfaction with physical therapy services. The subject was an infant girl with Erb's palsy who participated in this study from age 8 months to age 20 months. An A-B-A withdrawal single-subject design was used. The patient's progress was assessed by using the T.I.M.E. The amount of crying was documented in the Crying Log. A parent satisfaction questionnaire was administered three times over the course of the study. The subject's progress in the music intervention period increased on three of five primary subtests of the T.I.M.E. The amount of crying decreased and parent satisfaction increased when music was played during therapy. Music may be used by pediatric physical therapists to decrease the patient's crying, increase parent satisfaction, and possibly to increase the child's rate of progress. Further research conducted with a group of infants and toddlers may help generalize these findings to a wider patient population.

Effects of music on crying behavior of infants and toddlers during physical therapy intervention

PURPOSE

This study was designed to investigate the effects of music on the amount of time that infants and toddlers cried during physical therapy sessions.

METHODS

An A-B-A withdrawal multiple single-subject design was used with 9 infants and toddlers with or at risk for developmental disabilities. Music was played during therapy in the intervention period but not in the baseline periods. The number of minutes that the participants cried was documented in a Crying Log. Results were analyzed using a celeration line approach and descriptive statistics.

RESULTS

Responses to music varied among the participants, with 6 of 9 children crying less when music was used during therapy.

CONCLUSIONS

Infants and toddlers with or at risk for developmental disabilities may benefit from the use of music during physical therapy to reduce crying. Effects of music on other aspects of infant and toddler behavior need to be studied.

Practice guidelines for music interventions with hospitalized pediatric patients

Music therapy is an effective complementary approach that can achieve specific therapeutic outcomes in the clinical management of pediatric patients. Growing research on music interventions has generated scientific knowledge about how this modality benefits patients and has formed the basis for effective protocols that can be used in practice. Although it can be challenging to translate research-based protocols into routine clinical care at the bedside, it is essential that music therapy interventions be aligned with evidence-based information and that accepted standards be established by the music therapy discipline to achieve the greatest benefit. The importance of partnerships between nurses and music therapists is emphasized to enhance the success of music-based treatments. This discussion synthesizes research findings that can be used to design pediatric practice guidelines in the application of music therapy.

A música como recurso no cuidado à criança hospitalizada: uma intervenção possível?

Trata-se de um estudo bibliográfico realizado a partir das bases de dados MEDLINE e LILACS e vias não-sistematizadas, no período de 1994 a 2004. Teve como objetivo analisar a produção bibliográfica da enfermagem pediátrica quanto à utilização da música como recurso terapêutico no espaço hospitalar, a fim de identificar o estado do conhecimento desta área nesse campo. Da análise do material empírico, emergiram três unidades de significados: o cenário, as intervenções e as repercussões. Os resultados evidenciaram os benefícios da música para a criança hospitalizada, seus familiares e equipe de saúde e constatou-se que este recurso pode ser utilizado no espaço hospitalar como uma intervenção de baixo custo, não-farmacológica e não-invasiva, promovendo um processo de desenvolvimento que visa à saúde da criança, da família e dos trabalhadores.

Evaluation of pain management interventions for neonatal circumcision pain

INTRODUCTION

The purpose of the study was to determine the efficacy of music and eutectic mixture of local anesthetics (EMLA) on pain responses of neonates undergoing circumcision.

METHOD

A randomized, double-blind experimental design was used with 23 neonates. Pain response was measured using an observational pain intensity rating scale and the physiologic parameters of heart rate, respiratory rate, oxygen saturation levels, salivary cortisol levels, and length of cry. Each infant's state was examined for a potential contribution to the pain response.

FINDINGS

Infant state, salivary cortisol levels, and respiratory rates were not significant. Pain ratings had considerable variability for all treatment conditions, but both single treatment groups had less pain by the end of the procedure. The heart rate was significantly lower for the EMLA group and remained stable for the music group. Oxygen saturation differences were statistically significant for the music group (P =.02) and approached significance for the EMLA group.

DISCUSSION

Preliminary support was provided for the efficacy of EMLA and music to contribute to the pain relief of neonates undergoing circumcision. Further study is warranted. Neonates deserve interventions that will provide them with a less painful start in life.

The specialist role of the music therapist in developmental programs for hospitalized children

Music therapy is used to address the needs of hospitalized children in the attainment of their normal growth and development milestones. Clinical practice literature proposes that the achievement of musical milestones parallels the developmental competence achieved in the areas of gross motor and fine motor skills; speech, language, and communication skills; sensory motor skills; and social and interactive skills. Pediatric health care workers are encouraged to use music appropriately in their work settings and, where possible, consult and liaise with a registered music therapist, that is, a trained and qualified practitioner, to achieve best practice outcomes in this field.