International Journal of Pediatrics
Volume:9 Issue: 86, Feb 2021

Mucopolysaccharidosis type III (MPS III), also known as Sanfilippo syndrome, is an autosomal recessive, neurodegenerative lysosomal storage disorder. Substantial challenges for airway manage ment and endotracheal intubation are predictable due to the MPS patients' specific phenotypic, facial, and airway characteris tics. In studies concerning various types of MPS, the incidence of difficult endotracheal intubation ranges between 28%-44%. This study intends to present a case with MPSIIIA, who aspirated her tooth during endotracheal intubation due to acute respiratory failure. This study reports a 12.5 year-old girl who presented with MPSIIIA and aspirated her tooth during endotracheal intubation due to acute respiratory failure resulting in lung lobe segmentectomy. The majority of MPS patients’ intubation and airway maintenance are hard and get even more difficult by age because of their mental retardation and oral health deteriorating, which may require tracheostomy.

Nowadays, students' feedback regarding different aspects of training provided for them are constantly monitored and explored as an essential factor in medical universities' quality monitoring. We aimed to investigate the attitude of medical students and pediatric residents in the pediatric wards of Mashhad University of Medical Sciences’ training hospitals to examine the existing educational conditions and its challenges, and improve teaching quality. The present research is a cross-sectional study whose population consists of pediatric residents and medical students who are working in the pediatric wards of training hospitals affiliated with Mashhad University of Medical Sciences, Mashhad, Iran in 2020; 40 individuals have been selected through convenience sampling. The samples then filled a researcher made questionnaire, and the obtained data were analyzed using SPSS v.16 software. Average score of attitude toward educational role of pediatric residents based on the view of residents and medical students was 44.80 ± 9.49 and 37.25 ± 8.86, respectively. Fifty percent of residents and 15 percent of medical students agreed with the educational role of pediatric ward. Results of independent t-test demonstrated that there is a significant difference between how residents and interns regard the educational role of pediatric residents in training hospitals (P = 0.0.13). The present study’s results revealed that residents attribute more importance to the educational role in comparison to medical students. The educational role of the residents in training the medical students must be considered of great importance as an exemplary policy in medical universities.

Background :

The purpose of this study was to investigate the role of traumatic childhood experiences in predicting emotion regulation and object relations in patients with irritable bowel syndrome.

Materials and Methods :

The research method was descriptive-correlational that was performed on 135 patients with irritable bowel syndrome, including 58 men and 77 women, who were selected by convenience sampling method from those referred to the gastroenterologist. Participants completed the childhood trauma, emotion regulation, and Object Relations questionnaire. Data were analyzed by Pearson correlation coefficient and simple regression statistical methods.

Results:

 The results of the study showed that the total score of childhood trauma significantly predicts poor emotion regulation in the subscales of depression (P <0.01), and anxiety (P <0.05), as well as the subscales of object relations including egocentrism (P <0.01), alienation (P <0.01), incompetency (P <0.01), and attachment (P <0.05).

Conclusion:

 It can be inferred from the research findings that traumatic childhood experiences, especially emotional experiences, play a decisive role in emotion regulation and object relations of patients with irritable bowel syndrome. Therefore, special attention should be paid to the prevention and treatment programs of these patients.

We aimed to review interventional studies on the effect of acupuncture, acupressure, and massage techniques on the symptoms of breast engorgement and breast milk volume. Systemic search of online databases (Medline, Cochrane, EMBASE, Web of Science, and Scopus), for randomized control trial and non-randomized prospective or retrospective clinical studies which were published up to Nov 2020, were done. No language or time restrictions were considered. Study selection was done by two reviews. Nine studies were included. In the first study, no significant difference was found in the mean breast milk volume between the two intervention groups (GB21, LI4 and SI1 acupoints), and control group. In the second study, the group receiving acupressure on the SI1, ST17 and CV18 acupoints exhibited a significant increase in the breast milk production. In the third study, the co- administration of affirmation relaxation and acupressure enhanced the breastfeeding self-efficacy (p = 0.045), and the breast milk volume (p = 0.033). In the fourth study the results revealed a significant difference in the mean breast milk volume in breast acupressure and oxytocin than control groups. In the fifth study, treatment with acupuncture significantly increased exclusive breastfeeding in acupuncture group. In the sixth study, milk production was significantly higher in Tuina therapy compared to the control group. Acupressure and acupuncture were effective onbreast milk volume and breast engorgement. Treatment with acupuncture and acupressure on GB21, LI4 and SI1, ST17 and CV18 acupoints, could improve milk volume. Also, combination of acupressure with relaxation or oxytocin massage could improve breast milk production. Acupressure and acupuncture can decrease breast engorment and breast pain in lactating mothers, too.

Background:

 A physical education lesson at school allows comprehensive physical development of children at school. The present study was aimed at studying the effect of physical exercise on the memory of schoolchildren in general education schools in Russia. We aimed to determine the impact of exercise Classics on the development of memory in children 9-10 years old.

Materials and Methods :

A pedagogical study was conducted in Kirov (Russia) in 2020, at secondary school No. 60. The control group was engaged in a standard program of physical culture. The children in the experimental group additionally used the exercise Classics in each lesson. The study was conducted over a period of 9 months, in which forty 9-10-year-olds took part. Physical education classes were held 2 times a week for 40 minutes each lesson. The level of development of coordination abilities was assessed by the Shuttle run test, and the children's memory indicators were assessed by the Jacobs Method test. Data were analyzed using Bio-stat 2009, Microsoft excel 2016 programs.

Results:

 In control group, in the Shuttle run test, the indicators improved by 2.9% (P>0.05), and in the test for the level of memory development, the indicators improved from 5.7±0.6 to 5.9±0.4 (P>0.05). In experimental group, in the Shuttle run 3x10 m test, performance improved by 14.1% (p <0.05), and in the Jacobs Method test, performance improved from 5.4±0.3 to 6.5±0.4 (p <0.05).

Conclusion :

These results indicate the effectiveness of using Classical exercises in physical education lessons when working with younger schoolchildren.

Children with Diabetes Mellitus face numerous challenges and they rely on coping strategies for managing them. This review was done to assess effective factors on coping skills of these patients.  

This is a systematic review on the effective factors on coping skills of children with diabetes mellitus. Data bases of Medline, Scopus, EMBASE, and Google Scholar were systematically reviewed for cross-sectional, cohort, case-control and randomized controlled trial assessing the effective factors on coping skills and strategies in diabetes, English articles without date restriction until Oct, 06, 2019. We included 543 articles and after reviewing and evaluating by Joanna Briggs Institute Critical Appraisal tools checklist, 14 articles remained for analysis.  

A review of 14 articles showed different scales were used for assessment of coping skills in the absence of a comprehensive one. Also, demographic factors, gender, social economic status, family size, sibling, disease variables, school performance, puberty, and metabolic control were factors assessed in different studies, but none of them were significant in all studies.  

It seems in studies there is a lack of a comprehensive, standardized coping assessment tool appropriate for children and adolescents considering age, gender, puberty, socioeconomic status, and different psychosocial factors.

Human T cell lymphotropic virus type I (HTLV-1) infection is endemic in specific regions of the world, including northeastern Iran. Besides mother to fetus transmission, it can be transmitted through breast feeding, sexual contact, and blood transfusion. The aim of this study was to determine the frequency of HTLV-1 in children.

This cross-sectional study was conducted on children from 6 months to 14 years of age hospitalized in Imam Reza Hospital between January 2016 and January 2017. HTLV-1 antibody testing was done on all patients admitted within one year, and the positive results were further confirmed by Polymerase chain reaction (PCR). After determining the frequency, the types of feeding and possible transmission ways of the virus were investigated.

Out of the 1358 children admitted, 758 entered the study and were tested for HTLV-1 antibody. The result was positive in 58 patients (7.65%) who were further tested by PCR and 11 (1.45%) had positive antibody result. Out of the 58 positive children, 28 (48.3%) were male and 30 (51.7%) female. Most of the children were in the age range of 6 to 30 months and breastfed. In terms of location, most of them lived in Mashhad (58.62%).

Our results demonstrated that the frequency of HTLV-1 antibody among children of 6 months to 14 years was 7.65%. They were tested by PCR and 1.45% were positive. This region therefore still remains an endemic area for HTLV-1 infection.

Immunosuppressed children with cancer remain a vulnerable group for acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Up to now, there is no specific antiviral agent or vaccine for this novel virus. Increased surveillance and preventive strategies are necessary in order to reduce the number of cancer patients who have been infected with Coronavirus disease (COVID-19). Education of patients, parents and health workers about these preventive strategies is of critical importance in reducing the risk of exposure to this virus. Consideration of risks and benefits regarding active intervention in the cancer patients during COVID-19 outbreak must be individualized case by case. Minimizing outpatients’ visits and also reduction of elective admissions or surgeries can help in mitigating exposure and potential transmission. Additionally, the oncology community should balance a delay in cancer treatment against the risk of potential COVID-19 exposure. Limiting the exposure of cancer patients to clinics and departments and also modifying the therapeutic options in order to reduce the probability of myelosuppression, if feasible, could be the main goal. This review article summarizes the preventive strategies regarding cancer patients during this extraordinary time.

Background:

 Neonates are the most vulnerable population in terms of temperature control. In general, neonates are not able to protect themselves against fluctuations in ambient temperature. We aimed to compare the effect of the prone and supine positions on temperature of premature neonates.

In this crossover clinical trial, a total of 22 premature neonates between 32-36 weeks of gestation admitted to the Neonatal Intensive Care Unit of Amir Kabir Hospital, Arak, Iran, were selected through purposive sampling technique, and were randomly assigned into groups 1 and 2. Newborns in group 1 were first placed in a prone position (i.e., the first period for 3 hours), and then in a supine position (i.e., the second period for an additional 3 hours). The reverse procedure was applied to the intervention group 2. A trained nurse measured body temperature every minute for three hours with a digital thermometer.

Mean age of newborns was 10.38±9.69 days and mean birth weight was 2297.72±693.75 g. The mean temperature at various times in the prone position was significantly higher than the prone position (p <0.05). The mean of body temperature at 1st, 2nd and 3rd hours in the prone position was 36.66 (±0.30), 36.57 (±0.29), and 36.88 (±0.35) and in supine position was 37.18 (±0.09), 37.16 (±0.16), and 37.17 (±0.17), respectively and in all three times, the temperature difference between the two positions was statistically significant (p <0.01).

Based on the results, placing of premature neonates, admitted to the NICU, in the prone position reduced the body temperature of those with fever or hyperthermia in a non-invasive and non-pharmacological manner and minimized their thermal fluctuations.

Gastrointestinal bleeding (GIB) and especially upper GIB in children under 18 years, is underestimated compared to the adult population. Although mortality rate in this group of patients is reported to be about 2 percent, the role of early endoscopy in diagnosis and treatment of underlying causes and prevention of recurrence is essential. We aimed to evaluate endoscopic findings in children with hematemesis and assess the relationships between these findings and demographic/clinical variables.
In this cross-sectional study, we have studied the medical records of 102 patients from November 2017 to November 2018, under 18 years who referred to Children’s Medical Center with hematemesis and had undergone the endoscopic procedure. The demographic information, past medical history, history of using NSAIDs (Non-Steroidal Anti-inflammatory Drugs), accompanying symptoms, laboratory records, and endoscopic findings were investigated.
Participants are mostly between 6-11 years old (52.9%, n=54). The most common accompanying symptom is non-bleeding vomiting (52%, n=51). Patients with a history of using NSAIDs had a significantly higher rate of gastric ulcers (P-value

Abnormal pubertal development and fertility are among the frequent complications in Turner’s syndrome. Although elevated level of gonadotropins in Turner’s syndrome patients is well documented, the possible correlation with the karyotype findings and anthropometric features of patients is not clearly addressed. The present report aimed to evaluate the relation between the follicle-stimulating hormone (FSH) serum level and cytogenetic findings in Iranian Turner’s syndrome patients.

Abnormal pubertal development and fertility are among the frequent complications in Turner’s syndrome. Although elevated level of gonadotropins in Turner’s syndrome patients is well documented, the possible correlation with the karyotype findings and anthropometric features of patients is not clearly addressed. The present report aimed to evaluate the relation between the follicle-stimulating hormone (FSH) serum level and cytogenetic findings in Iranian Turner’s syndrome patients.

The mean age of the Turner’s syndrome patients was 9.78 years and most of the patients were mosaic for Turner syndrome (54.3%). Although the FSH level increased, there was not any significant different between the FSH level in the initial evaluation and the second evaluation within the entire study population (P=0.605). Among those who were mosaic for Turner’s syndrome and those with 45,XO karyotype, the FSH level increased during the follow up (P=0.476, and P=0.357, respectively).

The present study demonstrated that although Turner’s syndrome patients face abnormal FSH levels, there is not any significant relation between the cytogenetic findings as well as anthropometric characteristics including height, weight and BMI with the serum FSH levels.

Diffuse bronchiectasis is an irreversible abnormal dilation of proximal subsegmental bronchi. The aim was to investigate and compare CFTR gene mutations and clinical presentations in children with idiopathic bronchiectasis.

In a cross-sectional study, all children with idiopathic bronchiectasis who were hospitalized from 2019 to 2020 in Tabriz Children’s Hospital, Iran, were reviewed. Bronchiectasis confirmation was based on signs, symptoms, and HRCT findings. Data was collected through medical records, medical history, clinical examination, and para-clinical examination. CFTR variants were examined by liquid chromatography, direct sequencing, and multiple probe ligations. Then children were divided into two groups based on variants identified in the CFTR gene and compared in terms of demographic, clinical, and para-clinical findings. Descriptive statistics, Chi-square Tests, and independent samples t-test was used to analyze the data using SPSS software version 22.0.

Out of 21 patients, 0 (47.6%) children were males with a mean age of 9.75 years. Out of 21 children with diffuse bronchiectasis, five clinically significant CFTR-related gene variants were identified (group 1). Other patients either had only single polymorphism or no variants related with CFTR (group 2). Age, FEV1 and sweat test were lower in group 1 than in group 2.

We observed the CFTR variants in heterozygote form in children with diffuse bronchiectasis with a normal or borderline sweat test. Therefore, it is necessary to determine whether DB is a part of CFTR-Related Diseases failing to meet the diagnostic criteria of Cystic fibrosis or a disease independent of Cystic fibrosis.

Background:

 Fissure sealant therapy is one of the most effective methods for preventing dental caries. This study aimed to investigate the effect of parental education on fissure sealant in the sample of Iranian preschool children.

This experimental study was conducted in Sanandaj, West of Iran, in 2019. A total of 120 parents of preschool children were randomly selected and divided into control (n = 60), and intervention (n = 60) groups. The required data were collected by a questionnaire based on the theory of planned behavior. It consisted of two sections: demographic information and theoretical constructs. The intervention group received four sessions of 45-60 minutes. Education was conducted through lectures and question and answer using pamphlets, brochures, and dental manikins. Data were analyzed using SPSS software version 20.

The intervention and control groups were homogeneous ‎before ‎education. ‎They were similar in terms of mean scores of the planned ‎model. However, after an educational intervention, all the scores increased, including the mean attitude score (from ‎‎3‎‏.‏‎09±0.47‎‏ to ‎4.07±0.64)‎, subjective norm score (from 3.2±‎‏0.45 to ‎‎3.90±‎‏0.52), perceived behavioral control score (from 3.172±‎‏0.31‏‎ to 3.73±‎‏0.40)‏‎, ‎behavioral intention score (from 3.33±‎‏0.58‏‎ to 4.40±‎‏0.62‏‎), practice score ‎(from ‎‏0‏‎ to ‎‏19.41‏‎±0.6), and knowledge score (from 1.85±2.23 to 7.17 ‎‎±1.31). Besides, the difference was statistically significant (p <0.05). Also, changes in model ‎constructs and knowledge were statistically significant in two ‎groups (p <0.05).‎

According to the results with implementing‏ four educational intervention sessions based on the theory of planned behavior ‎on fissure sealant can help increase the fissure sealant rate. ‎

Background :

For parents with sick children, the health care team is not the only source of receiving information, they try to use different sources. We aimed to evaluate the information seeking behavior of parents regarding health and medical issues.

This cross-sectional study was performed on parents of children referred to Dr. Sheikh Hospital and Hazrat Rasoul Center, Mashhad, Iran, from 2016 to 2018. 550 people filled an indigenous reliable questionnaire (a tool to evaluate information seeking behavior of parents of sick children) with Cronbach's alpha coefficient of 0.934. The exclusion criterion was parental dissatisfaction with participating in the study. The questionnaire is organized in 40 questions and 6 sectionsincluding demographic information, needs and motivations about data search, Internet usage, questions about data resources, obstacles to data search, and impact of data.

Parents searched various resources to obtain information about child health especially regarding the diagnosis of the child's disease, diet, and child growth and more than half of parents spent less than 2 hours per week for getting information. 31.8% of parents searched the Internet 2 to 5 times a week for health information. The most important reasons for parents to search the Internet were to get more information than what the doctor tells those (53.08%), and to look for alternative and traditional treatments (36.9%). According to parents, the most important limitation of the information obtained from the Internet can be its unreliability (63.09%).

The results showed that medical staff and the Internet had priority over other sources in obtaining information about the child's illness, however, health care team was trusted more by the respondents.

Background :

Helicobacter pylori has become very important recently due to infecting around 50% of the population worldwide. This infection can cause peptic ulcer disease and gastric cancer. This study aimed to evaluate the efficacy of common triple treatment, sequential treatment, and other regimens for Helicobacter pylori eradication in children.

In this retrospective cohort study, 40 children who were diagnosed with Helicobacter pylori infection by endoscopic and pathologic features in the Children’s Medical Center of Tehran, Iran, in 2018 were included. The questionnaire was completed by telephone interview. Types of protocols include triple therapy (proton pump inhibitors with clarithromycin and amoxicillin or metronidazole for 2 weeks), sequential therapy (proton pump inhibitors with amoxicillin for 5 days followed by proton pump inhibitors with clarithromycin and metronidazole for 5 days), and other treatments (every protocol except triple and sequential regimens). At the end, we compared the efficacy of the different protocols for eradicating this infection by urea breath test or stool antigen test 8 weeks after therapy.

The age of patients with and without successful eradication was 8.12 and 7.8 years, respectively (p=0.8). There was no significant difference between both sexes (p=0.999) in the frequencies of eradication. The eradication rate of Helicobacter pylori was 95.5% in sequential therapy, 100% in conventional triple therapy, and 87.5%in other regimens. There was no significant difference between different protocols (p=0.422).

Determining first-line treatment for eradicating Helicobacter pylori infection is important to increase treatment success and reduce rate of secondary antimicrobial resistance. Our study showed that sequential treatment is as effective as conventional treatment in eradication of this infection in children.

Perceived threat is particularly important in health-related behaviors. The aim of this study was to explain the perceived threat of unhealthy and unsafe eating behaviors in Iranian adolescent girls.

In this qualitative study, directed content analysis was used and participants were selected by purposeful sampling. Data were collected using focus groups and semi-structured, in-depth individual interviews with 60 girl students of the eighth grade who studied in the government schools of Shiraz City, Iran in 2019. Sampling continued until data saturation was achieved. Data were analyzed by Graneheim and Lundman's approach of conventional content.

From the data analysis, five categories were drawn. Perceived susceptibility comprised of (1) disease risk-increasing factors and (2) disease risk-decreasing factors and perceived severity consisted of (3) individual, (4) familial, and (5) social consequences of the disease. The perceived susceptibility consisted of the subcategories, namely, biological susceptibility or body's protective mechanisms, individual behaviors, and risky or protective environmental factors for food and health safety. Perceived severity included the subcategories: physical, mental, educational, and medical problems for the individual, psychosocial problems, and imposing heavy treatment costs on family, economic, and social problems for the community.

The perceived threat of unhealthy and unsafe eating behaviors in adolescents includes perceptions of disease risk increasing and disease risk-decreasing factors, as well as personal, familial, and social consequences following disease development. Understanding these perceptions can help adolescents engage in health-promoting eating behaviors.

Background :

Methotrexate is a chemotherapy drug used in high doses to treat malignancies that can lead to serious liver damage, especially cirrhosis in a dose-dependent manner. We aimed to evaluate the hepatic complications, 10 years after treating children with hematologic malignancies by high-dose Methotrexate regimen.

In a descriptive-analytical study, all children with hematologic malignancies who received high-dose methotrexate for treating cancer and who were hospitalized in Tabriz Children’s Hospital, Tabriz, Iran, from 2008 to 2009 were included. Demographic data were extracted from medical records. Liver enzyme tests, ultrasonography, as well as a Doppler ultrasound of the portal vein were performed for all participants in the Tabriz Children’s Hospital. Data were analyzed using descriptive statistics. The Chi-Square test was used to examine the relationship between variables using SPSS software version 22.0.

Out of 30 patients, 18 cases (60%) were boys and 23 (76.67%) of patients had Acute Lymphoblastic Leukemia. ALT, Total BILL, and Direct BILL levels were increased by 13.33%, 13.33%, and 10% of cases, respectively. AST, PT, and PTT levels were normal in all patients. The liver and spleen spans were larger than normal in 26.67% and 40% of cases, respectively and 5 patients (16.67%) had grade 1 fatty liver. Port vein diameter was normal in all patients.

Based on the results of the study, it is possible to consider the long-term safety of high dose Methotrexate in terms of the development of severe liver disease following treating malignancies in children. However, patient follow-up is recommended to identify complications for years after discontinuing treatment.

Background :

Pain and anxiety are the common complications following surgery. The mother's recorded voice can be used to reduce the pain and anxiety. Current research aimed to investigate the effectiveness of the mother's recorded voice on the preoperative anxiety and postoperative pain in children undergoing surgery.

This clinical trial study was performed in two groups in the Ali Ebn Abitalib Hospital in Zahedan, Iran in 2019. Eighty children were selected using convenience sampling method and were randomly assigned into intervention group (n=40), and control group (n=40). In the intervention group, the mother's recorded voice was played through the TSCO TH 5335 wireless headphones for 10 min to the child. Anxiety was assessed by modified mYPAS. The pain was assessed 30 min after surgery by the FLACC and one hour after operation by TPPPS. Data were analyzed using software version 22.0.

The mean anxiety in the intervention group after playing mother's voice (52.82 ± 6.90) was significantly lower than before playing the mother's voice (57.12 ± 6.59), (P <0.001). The mean pain 30 min after surgery in intervention group (2.35 ± 1.09) was significantly lower than that in control group (4.9 ± 0.81), (P <0.001). Also, the mean of pain one hour after surgery in the intervention group (2.72 ± 0.716) was significantly lower than that in the control group (4.42 ± 0.675), (P <0.001).

The results suggest that the mother's recorded voice reduced the anxiety before surgery and pain after surgery in children; therefore, we propose that nurses can use the mother's recorded voice to control the pain and anxiety in children.

The aim of the present study was to investigate the structural model of student motivation based on the teacher-student relationship, school attachment, and metacognitive awareness through self-mediated disabling. The approach used in this analysis was the structural equation modeling correlation. The statistical population of this study included all male and female high school students in the 22.0 Tehran districts in the academic year of 2017-18 in the second year of high school. Based on the table by Jesse and Morgan, stratified random sampling was used to select 480 individuals. They were selected and answered the Motivation Questionnaire (AMS), Teacher-Student Relationship (IT-SR), School Attachment (SAQ), Metacognitive Awareness (MAI), and Self-Handicapping Scale (SHS). Pearson correlation with SPSS software version 20 and path analysis with Amos software was used to analyze the data. Demographic findings show that most of the sample cases are boys and 17-year-olds. It can be concluded that Teacher-student relationships has an indirect effect on Academic motivation by mediating role of Self-handicapping (p <0.05). But the indirect relationship between attachment to school with Academic motivation was  not confirmed (p>0.05). The results showed that the teacher-student relationship with academic motivation was significant and school attachment has a direct and significant relationship with academic motivation, while the indirect effect was not significant. Also, the relationship between metacognitive awareness and academic motivation with the presence of self-medicated mediation was directly and indirectly significant. Given the importance of the role of the mentioned variables on students' academic motivation, efforts should be made to create conditions for promoting students' academic motivation by creating a supportive and positive, active, and vibrant environment.

Effective pain control is a prerequisite for successful child dental treatment.This study was designed to evaluate the efficacy of tactile versus visual method to define needle insertion point of IANB for pulpotomy in children.

In this double-Blind, cross-over, randomized clinical trial, 40 children (7-9 years old) requiring primary mandibular second molars pulpotomy were recruited. Study was performed in Zahedan Dental School at 2016. Children were randomly divided into two groups. Group I received IANB using tactile method in the right side in the first session, and using visual method in the left side in the second session. Group II received the visual method for the right and the tactile method for the left in two sessions respectively. Objective and subjective pains during injection were recorded using SEM and FIS, respectively. Reaction during cavity preparation; recorded by SEM, was evaluated as sign of anesthesia failure. Data were analyzed using the Mann-Whitney U, Wilcoxon Singed Rank and Fisher's Exact Tests at a significance level of 0.05. 

Regarding tactile method, comparing groups I and II showed no significant difference in any of the variables (P> 0.05). About visual method two groups showed a significant difference only in subjective pain (P= 0.013). In group I, visual method showed significant differences in objective and subjective pain versus tactile method (p < 0.05). In group II, no significant differences were found between the two methods in variables. Totally, all variables were significantly different in favor of visual method versus tactile method (p <0.05).

The visual method reduced objective and subjective pain and yielded superior anesthesia success compared to tactile method.

Parents play an imperative role in building up their child's attitude towards dentistry. Among the several behavior management techniques, some are more accepted by parents; while, some others are condemned. This study aimed to evaluate the parents' acceptance of various behavior management techniques in pediatric dentistry. This descriptive-analytical study was conducted on 70 Iranian parents who sought dental treatment for their Based on the present findings, tell-show-do and hand-over-mouth were respectively the most and the least commonly accepted techniques among the studied Iranian parents.