Abstract
Background
Weighted blankets are one method to provide deep pressure touch sensations, which are associated with a calming effect on the nervous system. Weighted blankets have been reported to elicit a calming effect during stressful dental encounters and routine prophylactic visits in older adolescents and adults. Preliminary research suggests that weighted blankets are safe and feasible for children in both hospital and home settings; this, however, has not yet been examined in a paediatric dental environment.
Aim
To examine the feasibility, acceptability, and perceived effectiveness of a weighted blanket during paediatric dental care.
Design
This cross‐sectional study examined child, caregiver, and dentist‐reported responses to survey questions asking about their experience with the weighted blanket during care (n = 20 each per child and caregiver group, n = 9 dentists).
Results
The use of a weighted blanket is feasible, acceptable, and appropriate as reported by caregivers and dentists (means ≥ 4.70 on the Feasibility of Intervention, Acceptability of Intervention, and Intervention Appropriateness Measures). Few problems were described, and all groups overwhelmingly responded with enthusiasm, noted the blanket's potential for future use, and perceived that a weighted blanket improved care (means ≥ 4.10).
Conclusions
Study findings support the feasibility and acceptability of using a weighted blanket during routine, noninvasive paediatric dental care.
Keywords: acceptability, deep pressure, dental fear, feasibility, weighted blanket
Why this paper is important to paediatric dentists.
The use of weighted blankets to provide calming deep pressure touch sensations has gained popularity in common culture in recent years, recognized for their potentially therapeutic benefits.
This study supports the feasibility, acceptability, and perceived effectiveness of weighted blankets during routine, noninvasive paediatric dental care as reported by children, their caregivers, and their dental provider.
Future research should examine the effectiveness of weighted blankets—alone and in conjunction with other strategies—to improve overall patient experience and oral health outcomes for children with dental fear and anxiety.
1. INTRODUCTION
Dental fear and dental anxiety—terms often used interchangeably—are commonly combined in practice and research and referred to as dental fear and anxiety (DFA). DFA refers to the negative emotions experienced due to stimuli perceived as threatening in dental environments. 1 Up to 42% of children struggle with DFA, which is linked to adverse oral health‐related outcomes such as poor oral health, irregular dental attendance, dental behavior management problems, and the need for pharmacological methods. 2
Despite the prevalence and serious potential repercussions of DFA for paediatric patients, few interventions have been rigorously studied to determine their impact on decreasing DFA in dental care settings. 3 For example, distraction (e.g., virtual reality, music, and magic tricks), video‐based and in vivo modeling, and tell‐show‐do strategies are among the current nonpharmacological interventions that have been developed to manage DFA in paediatric populations. 4
Weighted blankets are one method to provide deep pressure touch sensations, which are reported to have a calming effect on the nervous system. 5 Deep pressure is a form of tactile stimulation based on sensory integration theory, which asserts that altering sensory input impacts how the nervous system processes information and that different sensory inputs can mediate an individual's sensory responsivity and adaptive behaviors. 6 Weighted blankets have been used across the lifespan to improve sleep and/or anxiety for individuals with clinical diagnoses (e.g., autism, attention‐deficit/hyperactivity disorder, and psychiatric disorders) as well as those without clinical diagnoses (i.e., no medical or psychiatric conditions).5, 7
In the dental setting, weighted blankets have been reported to elicit a calming effect during stressful dental encounters and routine prophylactic visits in older adolescents and adults.8, 9, 10 Preliminary research examining the use of weighted blankets suggests that they are safe and feasible for children in both hospital 11 and home settings 12 ; this, however, has not yet been examined in a paediatric dental environment. Therefore, as preparatory work for a subsequent five‐year randomized controlled trial utilizing a weighted blanket, this study aimed to examine the feasibility, acceptability, and perceived effectiveness of the use of a weighted blanket during paediatric dental care.
2. MATERIALS AND METHODS
2.1. Study design
This prospective cross‐sectional study was approved for human subjects by the Institutional Review Board at Children's Hospital Los Angeles (CHLA; CHLA‐21‐00273) and the University of Southern California (UP‐22‐00181).
2.2. Participants and recruitment
Participants included children, their caregiver, and their treating dental provider. Children were 6–12 years old, spoke English, were willing to participate in the study, and could understand and answer survey questions (i.e., no intellectual or developmental disability). Caregivers included legal guardians of the child who spoke English and were willing to participate. Participating dentists were second‐year dental residents in an advanced practice paediatric dentistry residency program at a paediatric dentistry clinic in a large urban children's hospital who agreed to participate.
Caregiver:child dyads were recruited from a convenience sample of children already scheduled to undergo dental treatment at the paediatric dentistry clinic. Research staff reviewed the dental clinic calendar to identify age‐appropriate participants; medical records were then reviewed to confirm eligibility. Caregivers were called prior to their child's appointment to inform them about their potential eligibility in the study and describe the study procedures. If research staff was unable to contact the caregiver, the family was approached in the waiting room before their scheduled appointment. If interested in participating, the child completed the assent process; the caregiver completed the consent process and reported the child's race/ethnicity, identifying all that applied: White, Caucasian; Black or African American; Asian; Native Hawaiian or other Pacific Islander; American Indian or Alaska native; Hispanic, Latino; and other. Dental residents were invited to participate and provided an information sheet; there were no negative repercussions for choosing not to participate.
No consensus currently exists regarding the appropriate sample size for a feasibility study, and recommendations vary widely, including 10–75 participants per group. 13 Taking into account that this study did not include hypothesis testing and was not seeking to estimate critical parameters for a future project, the target enrollment for this study was 20 caregiver:child dyads—still twice as large as the lowest recommendation.
2.3. Weighted blanket
Following consent and assent procedures, caregivers provided the child participant's weight. A commercially available* and appropriately sized weighted blanket (approximately 10–20% of body weight) 14 was then chosen for each child participant. Height and weight of each blanket varied as follows: extra small—32″ × 36″ and 5 lbs, small—36″ × 42″ and 8 lbs, medium—42″ × 54″ and 12 lbs, and large—54″ × 72″ and 16 lbs. All blankets were fabricated from 100% high‐quality soft cotton with child‐friendly patterns (e.g., monsters, waves, starry sky, and sharks), weighted with nontoxic PET pellets with pocketed construction ensuring even distribution of weight across the blanket, and were machine‐washable.
2.4. Procedures
Once the child was seated and reclined in the dental chair, the appropriately sized weighted blanket was placed on the child, covering them shoulders to feet. As dental treatments often had substantial waiting periods within the overall treatment (e.g., waiting between components of an orthodontic treatment), the blanket was applied only during the first portion of treatment in these noncontinuous instances. Children were informed that they could request the blanket be removed at any time. If independently requested by the child, they were allowed to keep the weighted blanket on during waiting gaps and later treatment components.
2.5. Measures
2.5.1. Feasibility and acceptability
Recruitment and enrollment
The number of caregiver:child dyads and dental residents approached compared with enrolled was tracked in order to examine recruitment and enrollment feasibility.
Retention and adherence
To assess the participation of those enrolled, we tracked the number of enrolled participants (children, caregivers, and dental residents) who completed all study‐related activities versus those who requested study procedures be terminated early or withdrew from the study.
Survey
Child, caregiver, and dentist participants each independently completed a self‐report survey immediately following the child's dental treatment (17 items, 39 items, and 37 items, respectively; a copy of the surveys may be requested from the first author). Participant demographics collected included child age, race/ethnicity, and sex.
Feasibility, acceptability, and appropriateness
The Feasibility of Intervention Measure (FIM), Acceptability of Intervention Measure (AIM), and Intervention Appropriateness Measure (IAM) assess indicators of implementation success. 15 Administered to caregiver and dentist participants, these reliable and valid tools each contain four items, scored on a 5‐point Likert scale ranging from “completely disagree” (1) to “completely agree” (5). 15 For each measure, scores are summed and then averaged to create a scale value, with higher scores indicating greater feasibility, acceptability, and appropriateness . 15
In order to obtain more detailed information regarding the feasibility and acceptability of using a weighted blanket during dental treatment, all participants (children, caregivers, and dentists) additionally completed items compiled from previously published acceptability‐related assessments.16, 17, 18, 19 Questions inquired about ease of use/effort (n = 2 questions per group), comfort (n = 6 child questions, n = 7 caregiver/dentist questions), familiarity (n = 2 child/dentist questions, n = 6 caregiver questions), compatibility (n = 1 child question, n = 2 caregiver questions, n = 4 dentist questions), and problems using the blanket (n = 1 question per group), and included dichotomous (yes/no) and Likert‐scale‐based answers. Respondents were also asked to explain and/or elaborate on certain items (e.g., did you have any problems with the blanket).
Field notes including clinical observations, any spontaneous statements made by participants, and occurrences of participation duration beyond that specified by the study protocol (e.g., continuing to wear blanket during waiting gaps in care) were recorded.
Perceived effectiveness
To obtain information regarding perceived effectiveness, all participants responded to survey items related to the perceived advantages of using the weighted blanket (n = 1 child question, n = 4 caregiver questions, n = 3 dentist questions), enthusiasm about the weighted blanket (n = 2 child questions, n = 3 caregiver/dentist questions), and questions about future use (n = 2 questions per group).
2.6. Data analysis
Descriptive statistics including mean, standard deviation, median, and range were calculated using the SAS statistical software version 9.4 (SAS Institute) to describe feasibility, acceptability, appropriateness, and perceived effectiveness.
3. RESULTS
3.1. Recruitment and enrollment
Research staff reviewed 58 patient charts for eligibility and approached 28 potentially eligible families; 20 families were enrolled (71%). Eight families declined to participate; of these, reasons included that they did not have time to complete the surveys after the appointment (n = 2), had dental fear or previous negative experiences at the dentist (n = 2), or did not provide a reason (n = 4). All dental residents approached agreed to participate (n = 9).
3.2. Retention and adherence
Of the 20 families enrolled, 95% completed all study‐related activities as outlined in the protocol (n = 19). The one child who chose to remove the weighted blanket prior to the completion of his dental treatment stated that “It is not time to sleep. It is time for the dentist. Take it off, please.” One hundred percent of dental residents completed all activities. No families or residents withdrew following enrollment.
3.3. Participants
Child participants (n = 20) were an average age of 9.20 years old (SD = 1.77) with an equal distribution of participant sex (n = 10 male, n = 10 female). Fifty‐five percent of caregivers identified their child as Latino/a/x (n = 11); other caregivers stated their child was White (n = 3), Asian (n = 2), or Armenian (n = 1). Race/ethnicity information was not disclosed for three participants. The majority of participants (n = 16, 80%) were medically complex with diagnoses including the following: chronic respiratory disease (e.g., chronic lung disease, asthma; n = 7); cleft lip and cleft palate (n = 4); congenital heart defect (e.g., coarctation of the aorta, mitral valve prolapse; n = 3); attention‐deficit/hyperactivity disorder (n = 2); gastrointestinal disorder (e.g., gastroesophageal reflux disease; n = 1); growth disorder (e.g., growth hormone deficiency; n = 1); Ehlers–Danlos syndrome (n = 1); and epilepsy (n = 1); four participants had multiple co‐occurring diagnoses. Twenty percent of participants (n = 4) were healthy with no documented medical diagnoses.
The majority of participating caregivers were female (n = 16).
3.4. Weighted blanket usage and treatment type
The weighted blanket was used for an average of 32.4 min (SD = 12.8), with an average active treatment time of approximately 16.3 minutes (SD = 5.8) (i.e., not including waiting gaps in care). Eleven participants underwent routine dental care (e.g., oral examination and dental cleaning), and nine received orthodontic treatment (e.g., follow‐up for head gear, replacement of wire).
3.5. Feasibility, acceptability, and appropriateness
Both caregivers and dentists overwhelmingly reported the intervention to be acceptable, appropriate, and feasible as reported on the AIM (m = 4.80 ± 0.40, m = 4.70 ± 0.46, respectively), IAM (m = 4.78 ± 0.45; m = 4.71 ± 0.46, respectively), and FIM (m = 4.81 ± 0.39; m = 4.70 ± 0.46, respectively).
Overall, all groups reported that the blanket was easy to use (overall category mean: child m = 4.33 ± 0.83, caregiver m = 4.80 ± 0.41, dentist m = 4.70 ± 0.52), comfortable (overall category mean: child m = 4.21 ± 0.89, caregiver m = 4.63 ± 0.71, dentist m = 4.68 ± 0.59), and compatible with dental care (overall category mean: child m = 0.95 ± 0.22 [scored 0/1], caregiver m = 4.59 ± 0.99, dentist m = 4.59 ± 0.71). Caregivers and children were, overall, not familiar with the use of weighted blankets at the dentist or any other location (overall category mean: child m = 2.45 ± 1.34, caregiver m = 2.44 ± 1.48), whereas dentists reported being familiar with the use of weighted blankets both in dental and nondental settings (overall category m = 3.88 ± 1.39) (Table 1).
TABLE 1.
Feasibility, acceptability, appropriateness, and perceived effectiveness of the use of a weighted blanket during paediatric dental care.
| Survey item | Participant group | |||||
|---|---|---|---|---|---|---|
| Child | Caregiver | Dentist | ||||
| M (SD) | Median (range) | M (SD) | Median (range) | M (SD) | Median (range) | |
| Feasibility, acceptability, and appropriateness | ||||||
| Ease | ||||||
| Blanket easy to use | 4.40 (0.75) | 4.5 (2–5) | 4.80 (0.41) | 5 (4–5) | 4.70 (0.57) | 5 (3–5) |
| I thought the blanket was easy to use | 4.25 (0.91) | 4 (2–5) | 4.80 (0.41) | 5 (4–5) | 4.70 (0.47) | 5 (4–5) |
| Overall ease mean | 4.33 (0.83) | 4 (4–5) | 4.80 (0.41) | 5 (4–5) | 4.70 (0.52) | 5 (3–5) |
| Comfort | ||||||
| Looked nice | 4.20 (0.83) | 4 (2–5) | 4.85 (0.37) | 5 (4–5) | 4.85 (0.37) | 5 (4–5) |
| Soft | 4.20 (0.95) | 4 (2–5) | 4.70 (0.47) | 5 (4–5) | 4.84 (0.37) | 5 (4–5) |
| Clean | 4.53 (0.51) | 5 (4–5) | 4.85 (0.37) | 5 (4–5) | 4.85 (0.37) | 5 (4–5) |
| Too hot | 3.95 (1.05) a | 4 (1–5) a | 3.75 (1.25) a | 4 (1–5) a | 4.10 (0.85) a | 4 (3–5) a |
| Blanket comfortable | 4.20 (0.95) | 4 (2–5) | 4.65 (0.59) | 5 (3–5) | 4.70 (0.57) | 5 (3–5) |
| Comfortable using the blanket | 4.20 (0.95) | 4 (2–5) | 4.80 (0.41) | 5 (4–5) | 4.65 (0.59) | 5 (3–5) |
| Felt comfortable with my child using blanket/felt comfortable treating child while they used blanket | – | – | 4.80 (0.41) | 5 (4–5) | 4.75 (0.55) | 5 (3–5) |
| Overall comfort mean | 4.21 (0.89) | 4 (1–5) | 4.63 (0.71) | 5 (1–5) | 4.68 (0.59) | 5 (3–5) |
| Familiarity | ||||||
| Heard of people using weighted blankets at the dentist | – | – | 2.90 (1.33) | 2.5 (1–5) | 4.55 (0.83) | 5 (3–5) |
| Heard of children using weighted blankets at nondental locations | – | – | 3.25 (1.44) | 3 (1–5) | 4.30 (1.03) | 5 (2–5) |
| Used weighted blanket at dentist before | – | – | 1.65 (0.99) | 1 (1–5) | – | – |
| Used weighted blanket for nondental reasons before | 3.25 (1.33) | 3.5 (1–5) | 2.60 (1.60) | 2 (1–5) | – | – |
| Used a weighted blanket before | – | – | 2.85 (0.99) | 3 (1–5) | – | – |
| Using weighted blanket at the dentist/treating a child using a weighted blanket is a new experience | 1.55 (0.75) a | 2 (1–4) a | 1.20 (0.94) a | 1 (1–5) a | 2.80 (1.54) a | 2.5 (1–5) a |
| Overall familiarity mean | 2.45 (1.34) | 2 (1–5) | 2.44 (1.48) | 2 (1–5) | 3.88 (1.39) | 4 (1–5) |
| Compatibility | ||||||
| Used weighted blanket during entire cleaning c | 0.95 (0.22) b | 1 (0–1) b | 4.80 (0.70) | 5 (2–5) | 4.55 (0.83) | 5 (2–5) |
| Weighted blanket would not require significant changes to existing routine at the dentist | – | – | 4.37 (1.21) | 5 (1–5) | 4.60 (0.75) | 5 (2–5) |
| Child using weighted blanket did not hinder ability to provide care | – | – | – | – | 4.75 (0.55) | 5 (3–5) |
| Possible to keep weighted blanket clean and hygienic for patients | – | – | – | – | 4.45 (0.69) | 5 (3–5) |
| Overall compatibility mean | 0.95 (0.22) b | 1 (0–1) b | 4.59 (0.99) | 5 (1–5) | 4.59 (0.71) | 5 (2–5) |
| Problems | ||||||
| Problems using weighted blanket | 0.15 (0.37) b | 0 (0–1) b | 0.05 (0.22) b | 0 (0–1) b | 0 (0) b | 0 (0) b |
| Perceived effectiveness | ||||||
| Perceived advantages/impact | ||||||
| Weighted blanket seemed to make child relaxed | 4.10 (0.97) | 4 (2–5) | 4.42 (0.90) | 5 (2–5) | 4.40 (0.68) | 4.5 (3–5) |
| Using weighted blanket will help my child/paediatric patients' get teeth cleaned | – | – | 4.37 (0.90) | 5 (2–5) | 4.75 (0.44) | 5 (4–5) |
| Using weighted blanket will improve my child/paediatric patients' experience at dentist | – | – | 4.40 (0.88) | 5 (3–5) | 4.75 (0.44) | 5 (4–5) |
| Using weighted blanket could improve experience of children with dental fear | – | – | 4.45 (0.76) | 5 (3–5) | – | – |
| Overall perceived advantages/impact mean | 4.10 (0.97) | 4 (2–5) | 4.41 (0.84) | 5 (2–5) | 4.63 (0.55) | 5 (3–5) |
| Enthusiasm | ||||||
| Enjoyed using weighted blanket | 4.26 (0.87) | 4 (2–5) | 4.55 (1.00) | 5 (2–5) | 4.35 (0.81) | 4.5 (3–5) |
| Liked using blanket | 4.25 (1.37) | 5 (1–5) | 4.65 (0.67) | 5 (3–5) | 4.60 (0.50) | 5 (4–5) |
| Would tell other parents about using weighted blankets for dental care | – | – | 4.6 (0.75) | 5 (3–5) | 4.75 (0.44) | 5 (4–5) |
| Overall enthusiasm mean | 4.26 (1.14) | 5 (1–5) | 4.60 (0.81) | 5 (2–5) | 4.57 (0.62) | 5 (3–5) |
| Future | ||||||
| Would like to use weighted blanket next time | 4.25 (0.91) | 2.5 (2–5) | 4.65 (0.67) | 5 (3–5) | 4.70 (0.57) | 5 (3–5) |
| Comfortable using blanket in the future | 4.30 (1.12) | 5 (1–5) | 4.85 (0.37) | 5 (4–5) | 4.75 (0.44) | 5 (4–5) |
| Overall future mean | 4.38 (1.02) | 5 (1–5) | 4.75 (0.54) | 5 (3–5) | 4.73 (0.51) | 5 (3–5) |
Note: Survey items paraphrased for brevity. Likert scale responses included 1: completely disagree, 2: disagree, 3: neither agree nor disagree, 4: agree, and 5: completely agree.
Reverse scored to enable overall category mean calculations (e.g., blanket is too hot [1—completely agree; 5—completely disagree]).
Dichotomous yes (1)/no (0) response.
Not all participants received a cleaning; some patients received orthodontic treatment.
Of those children who experienced a waiting gap during treatment, 85% independently requested to keep the weighted blanket on, despite not being required by the study protocol. Multiple children (n = 9) spontaneously stated that they liked the blanket and/or noted that it felt “soft” and “comfy.” Two caregivers were concerned that their child would not accept the use of the blanket—one due to a previous traumatic dental experience and the other due to the child refusing to use traditional blankets in the home— both child participants, however, willingly accepted and reported enjoying the blanket. Three caregivers stated their desire to purchase a weighted blanket for their home after the study experience, whereas two others noted they already had weighted blankets in their home. One caregiver described the use of the weighted blanket akin to swaddling their child when she was a baby, with the pressure from the blanket helping her to fall asleep, suggesting that the weighted blanket may relax her child during dental care.
Three child participants answered in the affirmative to experiencing a problem with the weighted blanket. The first participant reported that the blanket fell off the chair and they had to “pull it back up”; this participant, however, still chose to use the blanket throughout the entire dental encounter and reported that it was easy to use, comfortable, and they would like to use it at their next dental visit. The second participant noted that the blanket was too hot; nevertheless, after the removal of his sweater, he stated that “…it feels much better now. It feels good.” Based on survey responses, he indicated that the blanket was easy to use, comfortable, and he would like to use it at his next dental visit. The third participant did not like the experience of wearing the weighted blanket and reported that using the blanket “made [him] think it [his dental treatment] was way more serious”; this participant did not perceive the use of the blanket to be easy or comfortable and did not want to use it again in the future. The one child who chose to remove the weighted blanket prior to the completion of his dental treatment did not respond in the affirmative when asked whether he experienced a problem with the weighted blanket.
3.6. Perceived effectiveness
3.6.1. Perceived advantages/Impact of the weighted blanket on care
The majority of caregivers, children, and dentists agreed or strongly agreed that the use of the weighted blanket seemed to help the child relax during their dental treatment (m = 4.20, 4.10, 4.40, respectively). Caregivers and dentists felt that using a weighted blanket during treatment would make it easier for their child/patient to tolerate care at the dentist (m = 4.15, 4.75, respectively) and that using a weighted blanket would improve their child/patient's experience at the dentist (m = 4.40, 4.75, respectively). Caregivers likewise overwhelmingly agreed that using a weighted blanket could improve care at the dentist for children with dental fear (m = 4.45) (Table 1).
In addition, 65% of participant dyads spontaneously made a comment regarding the perceived effectiveness or advantages of the weighted blanket. For example, one child expressed excitement because they “didn't even cry this time,” another reported that it made them feel more relaxed, and another was so comfortable that she yawned and her caregiver laughed that “[the blanket is] putting her to sleep.”
3.6.2. Enthusiasm
The majority of caregivers, children, and dentists agreed or strongly agreed that the child enjoyed using the blanket (m = 4.55, 4.26, 4.35, respectively) and liked the blanket a lot (m = 4.65, 4.25, 4.60, respectively). Caregivers and dentists agreed that they would tell other parents about the possibility of using a weighted blanket to improve care and comfort for children at the dentist (m = 4.60, 4.75, respectively).
Almost 50% of participants spontaneously made enthusiastic comments about the weighted blanket. For example, a caregiver shared that their child liked the blanket because it was “like a big bear hug.” For one child participant, after the dental treatment was complete, they made a sad face and whimpered, pulling the blanket higher up onto their body, indicating that they were not ready to return the blanket yet. Another child expressed interest in the weighted blanket, striking up a conversation with the dentist and researcher asking “What are the little balls inside?” and “Look at all the animals! It looks like they are eating the plants!” when noticing the pattern on the fabric. Lastly, one dental resident stated that “This is an awesome idea. I would want to use one!”, while another described that using a weighted blanket was a simpler and easier option because “I've used sheets for procedure patients as much as I can…[because] sometimes kids like the pressure of the sheet wrapped around them like they are being tucked in bed.”
3.6.3. Potential future use
The majority of caregivers, children, and dentists agreed or strongly agreed that they would be comfortable using or treating children with a weighted blanket during dental care in the future (m = 4.85, 4.30, 4.75, respectively). Caregivers and children likewise agreed that they would personally like to use a weighted blanket the next time the child had a dental appointment (m = 4.65, 4.25, respectively). Dentists strongly agreed that they would like to utilize a weighted blanket for some children during dental encounters in the future (m = 4.70).
Two caregivers spontaneously mentioned how they believed the blanket could be effective at improving children's experiences, even during more complex dental treatments. For example, “I think this would be really good for when kids get things like cavities done,” and “I think this would be really good for him when he gets actual procedures done. Right now he came in for a follow up, so it wasn't a scary experience, but I think he would benefit from using it again for his other dental appointments.”
4. DISCUSSION
Results from this study suggest that the use of a weighted blanket to provide deep pressure touch sensations in a paediatric dental environment is feasible, acceptable, and appropriate as reported by children, caregivers, and their dental providers. Few problems were described in the study, and all participant groups overwhelmingly responded to the experience with enthusiasm, noted the blanket's potential for future use, and perceived that the use of a weighted blanket improved care.
According to an expert panel assembled by the National Institute of Dental and Craniofacial Research, preventing and managing DFA is a priority. 20 Beyond the more traditional basic behavior guidance strategies (e.g., distraction, modeling, and tell‐show‐do), additional techniques for patients with DFA may include sensory‐adapted dental environments (SADE), animal‐assisted therapy, and/or nitrous oxide‐oxygen inhalation. 4 Research also suggests that biofeedback, 21 breathing techniques, 22 and cognitive‐based therapy 23 may also support care for children with DFA. Many of these strategies, however, require training or additional personnel for implementation and may be time‐consuming and/or cost‐prohibitive. 24
Utilization of a weighted blanket during dental care is a simple and cost‐effective strategy, which does not pose any of these logistical hurdles regarding training, time, staffing, or cost. Although few previous research studies have examined the impact of a weighted blanket in the dental setting, all have been high‐quality rigorous randomized controlled trials with findings supporting the success of deep pressure touch sensations to influence autonomic activation for adolescent and adult populations during dental treatment.8, 9, 10
The efficacy of deep pressure sensations to improve dental care, however, has yet to be examined in a paediatric population, although it has been included as one component of a SADE. In these SADE studies, instead of a weighted blanket, a “butterfly” wrap and/or regular X‐ray lead apron was utilized to provide deep pressure sensations, with the SADE found to significantly improve behavioral and physiological stress in paediatric dental patients with autism as well as intellectual and developmental disabilities.25, 26 Although a SADE is scalable and requires minimal training or cost to implement, 25 the use of a weighted blanket in isolation may be an even simpler and cost‐effective strategy if it is found to be equally efficacious as a full SADE. In addition, weighted blankets may easily be used in conjunction with other traditional and nontraditional behavior guidance strategies techniques (e.g., tell‐show‐do, distraction, and breathing techniques).
Previous research has suggested that medical immobilization (i.e., papoose board) may have unanticipated calming benefits for children during care, 27 which may be due to the deep pressure tactile sensations inadvertently provided by the papoose. The use of protective stabilization techniques, however, is consistently rated as less acceptable by parents than basic behavior guidance techniques. 28 If the deep pressure tactile sensory input from weighted blankets is shown to exert similar benefits for paediatric dental patients, this technique would likely garner high acceptance—based on results from caregivers, children, and dentists in this study, the satisfaction reported in weighted blanket studies in nondental settings,7, 12 and the recent popularity surge of weighted blankets in common culture. 29 In addition, preliminary research suggests a decrease in protective stabilization during moderate sedation when weighted blankets were utilized. 30
Although this study adds to our understanding of the feasibility, acceptability, and perceived effectiveness of weighted blankets during paediatric dental care, several limitations should be noted. First, this study used a convenience sample of children already scheduled for dental care; participants had unknown DFA status, and the weighted blanket was used during a variety of different dental treatments. Future research should examine the effectiveness of weighted blankets for paediatric populations prone to experiencing difficulties during dental care, including dentally fearful children and children with special healthcare needs, as well as exploring potential moderators to the success of the weighted blanket intervention (e.g., previous dental experiences). Second, as this study primarily aimed to explore feasibility and acceptability, all participants completed only subjective self‐report assessments. Future research should explore the effectiveness of weighted blankets during paediatric preventive and restorative dental procedures using both subjective (e.g., behavioral measures) and objective (e.g., physiological measures) assessments of distress and anxiety.
The use of weighted blankets to provide deep pressure touch sensations has gained popularity in common culture in recent years, recognized for their potentially therapeutic benefits. Minimal research, however, has examined their use in dental settings. The results reported here are among the first to explore a weighted blanket during paediatric dental care, illustrating the feasibility, acceptability, and perceived effectiveness of weighted blankets as reported by children, their caregivers, and their providers. Future research should explore the use of weighted blankets—alone and in conjunction with other strategies—to manage anxiety and promote relaxation in paediatric dental patients.
AUTHOR CONTRIBUTIONS
L.I.S.D. and J.C.P. conceived the ideas; J.H. and E.G. collected the data; L.I.S.D. and R.M.G. analyzed the data; L.I.S.D. and R.M.G. led the writing; all authors contributed to and revised the manuscript for content.
CONFLICT OF INTEREST STATEMENT
The authors declare that there are no conflicts of interest regarding the publication of this paper. All authors have made substantive contribution to this study and/or manuscript, and all have reviewed the final paper prior to its submission.
ACKNOWLEDGMENTS
This work was supported by the National Institute of Dental and Craniofacial Research (UG3 DE031222). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Stein Duker LI, McGuire R, Hernandez J, Goodman E, Polido JC. Feasibility, acceptability, and perceived effectiveness of weighted blankets during paediatric dental care. Int J Paediatr Dent. 2025;35:519‐528. doi: 10.1111/ipd.13263
Footnotes
Sommerfly Sleep Tight™ Weighted Blanket; https://www.sommerfly.com/collections/weighted‐blankets/products/standard‐sleep‐tight%E2%84%A2‐weighted‐blanket.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
REFERENCES
- 1. Lu C, Zhang YY, Xiang B, Peng S‐M, Gu M, Wong HM. Management of fear and anxiety in dental treatments: a systematic review and meta‐analysis of randomized controlled trials. Odontology. 2023;11:20‐32. [DOI] [PubMed] [Google Scholar]
- 2. Stein Duker LI, Grager M, Giffin W, Hikita N, Polido JC. The relationship between dental fear and anxiety, general anxiety/fear, sensory over‐responsivity, and oral health behaviors and outcomes: a conceptual model. Int J Environ Res Public Health. 2022;19:1‐19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Dhar V, Randall CL, Marghalani AA, et al. Nonpharmacological behavior guidance for children during preventive dental visits: a systematic review‐part 1. Pediatr Dent. 2023;45:181‐196. [PubMed] [Google Scholar]
- 4. American Academy of Pediatric Dentistry . Behavior Guidance for the Pediatric Dental Patient. The Reference Manual of Pediatric Dentistry. American Academy of Pediatric Dentistry; 2023:359‐377. [Google Scholar]
- 5. Eron K, Kohnert L, Watters A, Logan C, Weisner‐Rose M, Mehler PS. Weighted blanket use: a systematic review. Am J Occup Ther. 2020;74:7402205010p1‐7402205010p14. [DOI] [PubMed] [Google Scholar]
- 6. Ayres AJ. Sensory Integration and Learning Disorders. Western Psychological Services; 1972. [Google Scholar]
- 7. Bolic Baric V, Skuthälla S, Pettersson M, Gustafsson PA, Kjellberg A. The effectiveness of weighted blankets on sleep and everyday activities: a retrospective follow‐up study of children and adults with attention deficit hyperactivity disorder and/or autism spectrum disorder. Scand J Occup Ther. 2023;30:1357‐1367. [DOI] [PubMed] [Google Scholar]
- 8. Chen H‐Y, Yang H, Chi H‐J, Chen H‐M. Physiological effects of deep touch pressure on anxiety alleviation: the weighted blanket approach. J Med Biol Eng. 2013;33:463‐470. [Google Scholar]
- 9. Chen H‐Y, Yang H, Meng L‐F, Chan P‐YS, Yang C‐Y, Chen H‐M. Effect of deep pressure input on parasympathetic system in patients with wisdom tooth surgery. J Formos Med Assoc. 2016;115:853‐859. [DOI] [PubMed] [Google Scholar]
- 10. Chen H‐Y, Yang H, Chi H‐J, Chen H‐M. Parasympathetic effect of deep pressure input on third molar extraction in adolescents. J Formos Med Assoc. 2019;118:1317‐1324. [DOI] [PubMed] [Google Scholar]
- 11. Eull D, Zachrison B, Nickel A. Feasibility trial of weighted blankets as an intervention for emergence delirium in postoperative pediatric patients. J Pediatr Nurs. 2022;62:30‐35. [DOI] [PubMed] [Google Scholar]
- 12. Gringras P, Green D, Wright B, et al. Weighted blankets and sleep in autistic children: a randomized controlled trial. Pediatrics. 2014;134:298‐306. [DOI] [PubMed] [Google Scholar]
- 13. Lewis M, Bromley K, Sutton CJ, McCray G, Myers HL, Lancaster GA. Determining sample size for progression criteria for pragmatic pilot RCTs: the hypothesis test strikes back! Pilot Feasibility Stud. 2021;7:40. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Mullen B, Champagne T, Krishnamurty S, Dickson D, Gao RX. Exploring the safety and therapeutic effects of deep pressure stimulation using a weighted blanket. Occup Ther Ment Health. 2008;24:65‐89. [Google Scholar]
- 15. Weiner BJ, Lewis CC, Stanick C, et al. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017;12:1‐12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16. Venkatesh V, Thong JY, Xu X. Consumer acceptance and use of information technology: extending the unified theory of acceptance and use of technology. MIS Q. 2012;36:157‐178. [Google Scholar]
- 17. Karahanna E, Agarwal R, Angst CM. Reconceptualizing compatibility beliefs in technology acceptance research. MIS Q. 2006;30:781‐804. [Google Scholar]
- 18. Moore GC, Benbasat I. Development of an instrument to measure the perceptions of adopting an information technology innovation. Info Syst Res. 1991;2:192‐222. [Google Scholar]
- 19. Carper MM, McHugh RK, Murray HW, Barlow DH. Psychometric analysis of the perceptions of computerized therapy questionnaire‐patient version (PCTQ‐P). Adm Policy Ment Health. 2014;41:104‐113. [DOI] [PubMed] [Google Scholar]
- 20. National Institute of Dental and Craniofacial Research . Summary of NIDCR workshop on addressing dental fear and anxiety: steps toward accelerating progress and building a cumulative science 2019. Accessed April 15, 2024. https://www.nidcr.nih.gov/grants‐funding/grant‐programs/behavioral‐science/workshop‐addressing‐dental‐fear‐anxiety
- 21. Dedeepya P, Nuvvula S, Kamatham R, Nirmala SVSG. Behavioural and physiological outcomes of biofeedback therapy on dental anxiety of children undergoing restorations: a randomised controlled trial. Eur Arch Paediatr Dent. 2014;15:97‐103. [DOI] [PubMed] [Google Scholar]
- 22. Levi M, Bossù M, Luzzi V, et al. Breathing out dental fear: a feasibility crossover study on the effectiveness of diaphragmatic breathing in children sitting on the dentist's chair. Int J Paediatr Dent. 2022;32:801‐811. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. Shahnavaz S, Hedman E, Grindefjord M, Reuterskiold L, Dahllof G. Cognitive behavioral therapy for children with dental anxiety: a randomized controlled trial. JDR Clin Trans Res. 2016;1:234‐243. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24. Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent. 2016;8:35‐50. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25. Stein Duker LI, Como DH, Jolette C, et al. Sensory adaptations to improve physiological and behavioral distress during dental visits in autistic children: a randomized crossover trial. JAMA Netw Open. 2023;6:e2316346p1‐e2316346p14. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26. Kim G, Carrico C, Ivey C, Wunsch PB. Impact of sensory adapted dental environment on children with developmental disabilities. Spec Care Dent. 2019;39:180‐187. [DOI] [PubMed] [Google Scholar]
- 27. Malik P, dos Santos BF, Girard F, Hovey R, Bedos C. Physical constraint in pediatric dentistry: the lived experience of parents. JDR Clin Trans Res. 2022;7:371‐378. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28. Massignan C, Soares JP, Pires MMS, et al. Parental acceptance toward behavior guidance techniques for pediatric dental visits: a meta‐analysis. Braz Oral Res. 2022;36:e0127p1. [DOI] [PubMed] [Google Scholar]
- 29. Brown D. Weighted blankets: here's how the trendy bedding got so popular 2019. Accessed April 20, 2024. https://www.usatoday.com/story/news/nation/2019/01/26/weighted‐blankets‐makers‐weigh‐products‐sudden‐success/2558957002/
- 30. McBeain M, Malone S, Jones RS. Weighted blanket use as an alternative to protective stabilization during moderate sedation. Pediatr Dent. 2022;44:340‐344. [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.