DOI: 10.1111/ipd.
12362
Parents’ acceptance and their children’s choice of pet for
animal-assisted therapy (A.A.T.) in 3- to 12-year-old children
in the dental operatory –A questionnaire-based pilot study
NIDHI GUPTA & TUSHAR YADAV
Department of Pediatric and Preventive Dentistry, Dr. G.D. Pol Foundation, Y.M.T. Dental College and Research Institute,
Kharghar, Navi Mumbai, Maharashtra, India
International Journal of Paediatric Dentistry 2018
Aim. To evaluate the parents’ acceptance to ther-
apy pets, child’s most favoured pet, child’s choice
of soft toy as compared to live pet, and child’s
preference of his own pet versus therapy pet.
Methods. Sixty-two children of age groups
3-6 year, 6-9 year, and 9-12 year were selected.
The data from completed questionnaires were
statistically analysed and subjected to z test,
Chi-squared test with P value<0.05 considered as
significant.
Results. The consent to the presence of pet was
given by 41.47% parents of 9- to 12-year-old chil-
dren, 34.15% parents of 6- to 9-year-old children
Introduction
Fear of unknown is one of the major reasons
for dental phobia. This leads to uncooperative
behaviour during dental visits, thus treatment
becomes difficult1. To reduce this anxiety,
nowadays, many dentists worldwide allow
their own pet in the dental clinic2. Dr. Boris
M. Levinson got his own dog Jingles as the
first known animal therapy dog in 1969 to
help a severely withdrawn child3. After this,
many animals have been used therapeutically
in many hospitals and mental health facilities.
But this has its own demerits. One of which
is that the dog may create nuisance in the
dental clinic as he is not trained, and he may
cause allergies to the patient as well as staff
which can prove to be unhygienic for the
dental practice4.
Correspondence to:
Dr Nidhi Gupta, Department of Pediatric and Preventive
Dentistry, Dr. G.D. Pol Foundation, Y.M.T. Dental College
and Research Institute, Flat No. S-504, Jal Vayu Vihar,
Phase- II, Sector-20, Kharghar, Navi Mumbai 410210,
Maharashtra, India. E-mail: dr.nidhig2910@gmail.com
© 2018 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
and 24.39% parents of 3- to 6-year-old children.
Children who chose dog as their preferred pet
were 56.7%; those who chose cat as their pre-
ferred pet were 44%. A majority of 3-to 6-year-
olds (63.15%) had dog & cat as their choice, while
6- to 9-year–olds (65.21%) & 9- to 12-year-olds
(40%) preferred dogs over all others. Dog was the
favourite pet of 46.8% children. More percentage
of children wanted pet provided by clinic.
Conclusions. Animal-Assisted Therapy (AAT) can
prove to be a good behaviour management tech-
nique if more parents are made aware and
informed about AAT; dog is one of the highly rec-
ommended pets for AAT, and therapy pet should
be preferred over home pet.
Therefore, Animal-assisted therapy (AAT)
has been introduced. AAT involves the inter-
action between a patient and a trained animal
that has been specially educated in this ther-
apy. The animals that conduct AAT are called
therapy animals5.
JoJo and Flossie are the most famous
trained dogs deployed in two paediatric dental
clinics. They sit on children’s laps, play with
the kids, and distract them from anything
unpleasant happening in their mouths. They
make the dental treatment enjoyable when
they are around6. Domesticated animals of all
kinds are eligible to be registered as therapy
animals7. Not only dogs there are other ani-
mals like cats, rabbits, fish, and tortoise can
be used for the animal therapy7.
Another integral aspect of child dental care
is to provide parents with complete informa-
tion of behaviour management techniques8 as
it is necessary to know the factors that influ-
ence parental perceptions. This delivery of
information provides a mechanism by which
parents can participate in treatment decisions
with full understanding of factors related to
their child0 s proposed dental care and helps in
1
2 N. Gupta & T. Yadav

reducing situational parental anxiety9. The Material and methods

dental literature has various studies reporting
parental acceptability of behaviour manage- Study design
ment techniques10–17, but no study has
This study was carried out on a sample of 62
reported the attitude of Indian parents to
children aged 3 to 12 years and their parents
allow the therapeutic pet in the clinic.
randomly selected from the department of Pae-
In India, to introduce the concept of AAT,
diatric and Preventive dentistry. And, ques-
we need to first find out about the child’s
tionnaire was filled to assess the acceptance of
choice with respect to his favourite pet, par-
parents and the choice of pet by the children in
ents’ acceptance to allow pet in clinic. Thus,
a dental clinic. This study is a questionnaire-
this study was undertaken with an aim of
based cross-sectional pilot study.
evaluating the parents’ acceptance to therapy
pets, child’s most favored pet, child’s choice
of soft toy as compared to live pet, and Sampling and sample size
child’s preference of his own pet versus ther-
Children and their parents who were willing
apy pet.
to participate in the study were 62. They
were randomly selected of the 100 parents of
Aim 3-to 12–year-old children who presented to
the department of paediatric and preventive
To find out the child’s choice of pet for ani-
dentistry for treatment. The parents of the
mal-assisted therapy in the paediatric dental
children were informed about the nature of
set-up as an aid to improve behaviour of the
the study. The age of the child was ascer-
child during the dental treatment.
tained from the date of birth. Approximately,
20 children from each age group, that is
Objectives 3-6 year (36-71 months), 6-9 year (72 to
107 months), and 9-12 year (108 to
1) To assess the parental acceptance to the
144 months) were included in the study
presence of therapeutic pets in the paedi-
making a total sample size of 62 (Table 1).
atric dental set-up as an aid to improve
behaviour of the child during the dental
treatment. Questionnaire
2) To find out the influence of age and gen-
The study was based on questionnaire which
der of children on the choice of thera-
included the age, gender, and questions
peutic pet
related to parent’s consent for therapy pet,
3) To find out the child’s preference for the
choice of pet of the child, child’s preference
following two questions:
of soft toy versus live pet, and child’s prefer-
a) Soft toy versus live pet
ence of his own pet versus therapy pet which
b) Own pet versus therapy pet

Table 1. Association of parents acceptance of pet and age of child.

Would you give

consent to allow an
animal pet

Age of child Yes No Total P value of chi-squared test

3-6 year (36 to 71 months) 10 9 19

6-9 year (72 to 107 months) 14 9 23 0.082#
9-12 year (108 to 144 months) 17 3 20
Total 41 21 62

#
Statistically non significant difference (P > 0.05).

© 2018 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Children’s choice of pet in dental clinic 3

was filled by the examiner. The questionnaire Parents’ acceptance according to age of child
contained multiple choice questions.
Of the total 41 children whose parents gave
Study subjects were selected using the fol-
consent for the presence of pet in the study
lowing criteria:
group, 17(41.47%) were parents of 9- to
The Inclusion criteria were:
12-year-old children, 14(34.15%) were par-
a. Parents of all socio-economic status irre-
ents of 6- to 9-year-old children, and 10
spective of their age, gender, income, educa-
(24.39%) were parents of 3- to 6-year-old
tional status, and occupation.
children. Parents of 9- to 12-year-old chil-
b. Patient’s parents who were willing to par-
dren were nearly 50% who gave consent.
ticipate and gave consent for the study.
Also this table says that as the age increases
c. Children aged 3 to 12 years of age.
there is more likelihood of parents giving
The Exclusion criteria were:
consent for pet in the operatory. This was a
a. Children with any Special health care needs.
statistically non -significant difference seen
with age group and consent (P > 0.05)
Survey procedure (Table 1).
Total number of children and their parents who
were interviewed was 62. Parents and children Gender and agewise preferences for choice of pet
were interviewed in English, Hindi, and Mar-
Children who chose dog as their preferred
athi by the investigator as per the preference of
pet were 21 boys (56.7%) of total 37 boys,
the parent and child. Power point image was
and 11 girls (44%) chose cat as their pre-
shown to child, which consisted of photographs
ferred pet of total 25 girls. There was a sta-
of most liked pets in the form of jpeg image.
tistically highly significant difference seen
Patient was asked to select the favourite pet
with gender and choice of pet (P < 0.01)
after seeing the image. The order of the pets
with a majority of girls having cat as their
shown was dog, cat, rabbit, and tortoise. A sin-
choice, while boys preferred dogs over all
gle investigator filled the questionnaire.
others. (Table 2a)
There was a statistically significant differ-
Statistical analysis ence seen with age group and choice of pet
(P < 0.05) with a majority of 3- to 6-year-olds
All completed questionnaires were analysed,
(63.15%) having dog & cat as their choice,
and the data were transferred on the Microsoft
while 6- to 9-year-olds (65.21%) & 9- to 12-
Office Excel sheet version 2010. The data were
year-olds (40%) preferred dogs over all others
subjected to statistical analysis using SPSS ver-
(Table 2b).
sion 21.0, IBM. Comparisons of proportions,
expressed as percentages of variables, was done
using z test. Chi-squared test was performed Favourite pet
for each variable to assess whether significant
differences were observed. P < 0.05 was con- Dog was the favourite pet of 46.8% children
sidered to be statistically significant. (Table 3).
In our study more number of children
opted for live pets as compared to soft toys
Results although this was not significant (Table 4).
The total sample comprised of 62 children
aged 3 to 12 years. A total of 62 completed
Own pet versus therapy pet
questionnaires were received. Approximately,
20 children from each age group, that is 3- The percentage of children who want pet pro-
6 year (36-71 months), 6-9 year (72 to vided by clinic (56.5%) is more as compared
107 months), and 9-12 year (108 to to children who want their own pet in the
144 months) were included in the study dental operatory. The result is not significant
making a total sample size of 62. as P < 0.05 (Table 5).

© 2018 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
4 N. Gupta & T. Yadav

Table 2. (a) Association of gender and Choice of pet. (b) Association of age group and choice of pet.

Which animals do you like as pets?

(a) Dog Cat Rabbit Tortoise Total P value of chi-squared test

Gender Males 21 3 8 5 37 0.008**

Females 8 11 5 1 25
Total 29 14 13 6 62

Which animals do you like as pets

(b) Dog Cat Rabbit Tortoise Total P value of chi-squared test

AGE 3-6 year (36 to 71 months) 6 6 2 5 19

6-9 year (72 to 107 months) 15 2 5 1 23 0.015*
9-12 year (108 to 144 months) 8 6 6 0 20
Total 29 14 13 6 62

**Statistically highly significant difference (P < 0.01).

*Statistically significant difference (P < 0.05).

Table 3. Child’s most favourite pet in percentage.

and toddlers who were more attached to dogs
Frequency Per cent were 60%, and cats were 40%, respectively.
This attachment to dogs in India comes from
Dog 29 46.8
Cat 14 22.6
the story related to the great cultural epic
Rabbit 13 21.0 ‘The Mahabharata’ where towards the end
Tortoise 6 9.7 when Yudhishtra was going back to his final
Total 62 100.0
resting place after finishing the battle of
Kurukshetra. One by one his family members
died and only his dog remained by his side.
Table 4. Soft toy versus live pet.
When, at last, he was about to reach the
Frequency Per cent P value of z test gates of Paradise, his dog was not allowed to
enter heaven. So Yudhishtra refused to enter
Valid 1 30 48.4
as he was a very loyal dog and stayed with
2 32 51.6 0.741#
Total 62 100.0 him till the end. And, dog was also God Vish-
nu’s Vehicle19.
#
Statistically non significant difference (P > 0.05). Dog could also be a favourite pet because
acc to Levinson3, dogs help protect some
Table 5. Own pet versus therapy pet.
young children from environmental dangers.
Frequency Per cent P value of z test Dog has a strong physiological effect because
it decreases the blood pressure, heart rhythm,
My own pet 27 43.5 0.14# and cortisol levels. It increases the dopamine
Pet of the clinic 35 56.5
Total 62 100.0
and oxytocin levels20. Pet ownership was
investigated amongst 9- and 10-year-old chil-
#
Statistically non significant difference (P > 0.05). dren. Sixty-seven per cent of the children said
they had a pet, and the most common pet
Discussion
was a dog, followed by cats and rodents. The
children with pets were asked which was
This cross-sectional questionnaire-based pilot their favourite; over half chose a dog, and
study was done to identify the most favoured 15% chose a cat21.
pet of the child. Dog was the favourite pet of The first objective was to assess the parental
46.8% children. Again this could be because acceptance to the presence of therapeutic pets
the most common pet is dog in Indian house- in the paediatric dental set-up. In our study
holds. According to Kidd and Kidd18, infants mostly parents of all age groups gave consent

© 2018 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

for the presence of pet, and 50% of the par-
ents were of 9- to 12-year-old children. So, as
the age increases there is more likelihood of
parents giving consent for pet in the opera-
tory. This finding is in accordance with a
study22, in which adolescents diagnosed with
severe psychiatric problems who received
AAT, their parents thought that their children
accepted the hospital experience and treat-
ment more readily, and there was a signifi-
cant improvement in their emotional
expression and social skills.
The second objective was to find out the
influence of age and gender of children on
the choice of therapeutic pet. In a study by
Kidd, no significant gender differences in the
percentages attached to dogs or cats18. But in
our study, boys who chose dog as their pre-
ferred pet were 56.7%, and girls who chose
cat as their preferred pet were 44%. So,
majority of girls had cat as their choice, while
boys preferred dogs over all others. This could
be because the most common domestic pet in
India is dog. In our study a majority of 3- to
6-year-olds have dog & cat as their choice,
while 6- to 9-year-olds & 9- to 12-year-olds
preferred dogs over all others. Cat was a pre-
ferred pet for younger children in our study
which could be because kittens being fluffy
feline are childhood favourites according to
American Academy of Pediatrics23. Whereas
according to a study24, children from 3 to
13 year old showed a significant preference
for dogs over cats. Similar results were seen
by Harlow and Bowlby in the 12- to 30-
month-olds, probably because dogs approach
babies more often than do cats25,26.
The last objective was to find out the
child’s preference for Soft toy versus live pet
and own pet versus therapy pet. In our study,
also more number of children opted for live
pets as compared to soft toys, although it was
not statistically significant. It was similar to
the study carried out by LoBue et al.27 using
live pets and soft toys, and they found that
adults as well as children preferred live ani-
mals over toys. Children’s behaviour was
observed towards two live animals versus a
variety of commonly used attractive toys such
as car, ball, rattles, airplane, doll, trucks: live
animals were fish and hamster which were
© 2018 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Children’s choice of pet in dental clinic 5
slow moving. Age ranged from 11 to
40 months. Children had more frequent
interactions with the animals than the toys.
However, the children did not spend more
time overall interacting with the animals than
with the toys, possibly because they could
pick up and manipulate the toys, whereas the
animals were in terrariums attached to the
wall. In our study, children opted for live pets
as compared to soft toys. Children might be
attracted to animals over toys because ani-
mals are animate objects.
It is seen that moving objects catches
infants’ attention, but this attention stays
only if it is reciprocal in nature. Because
live pets could actually respond and interact
with the babies, while the mechanical pets
could be only moved towards the infants.
This forms the basis of attachment in par-
ent–child relationships26,28, the same may
be true in child–pet relationships. Also,
according to a study29, 4- to 12-month-old
infants are more interested in live animals
when they were shown videos of a moving
animal and other of a moving artefact.
These results support the response given by
children in our study.
Although the percentage of children who
want the clinic pet is more than the ones
who want own pet which is in contrary to
these findings, Kidd and Kidd24 found that
98% of the 3-year-olds said that they loved
their family pets, clearly showing that they
had already formed human/companion ani-
mal attachments. According to Kidd and
Kidd18, infants preferred the familiar family
pet to the novelty of the toy mechanical ani-
mal. Possibly, the infant felt more secure in
the presence of the family pet and the parent
as against the presence of the stranger and
the strange toy animals.
According to Filitaire et al.30, he studied the
interactions of 2- to 5-year -old children with
dogs. The longest interaction occurred if the
dogs had been in the family before the chil-
dren were born. They concluded that dogs
play an important part in regulating interac-
tions with infants, so dogs’ behaviour may
contribute towards baby’s acquisition of struc-
tured, socially effective behavioural
repertories.
6 N. Gupta & T. Yadav
The other option for AAT is to have clini-
cian’s own pet. In this situation, the
scheduling the appointment with pet is
easy. But sometimes, the child may behave
negatively and try to cause physical harm
to pet resulting in the clinician to stop
treatment for child and remove the pet
from the room. This can be a major disad-
vantage. If there is excessive stress from
which an animal cannot escape, the animal
may initiate defensive behaviours like
growling or even biting.
Limitations
1) In the present study just a questionnaire
was developed by the authors on the
acceptance of the parents and their chil-
dren, a fear test could have been
included.
2) A larger sample size is required to obtain
considerable result. As it was only a
questionnaire-based study, some clinical
trials should be carried out with the help
of the animal-assisted therapy team with
therapy pet in the dental operatory to see
the influence of therapy pets on the chil-
dren’s behaviour.
3) The limbic system controls the heart rate
and oxygen saturation of the human
beings in situation of fear. The use of
pulse oximeter in patients’ fingers before
introducing the pet to the child in dental
clinic and post -treatment would be an
excellent biological marker. And, this
would be the proof that pets really
helped to relieve the anxiety in children
during dental treatment.
Conclusion
AAT can prove to be a good behaviour man-
agement technique if the following points are
considered.
1) More parents should be made aware and
informed about the AAT.
2) Dog is one of the highly recommended
pet for AAT.
3) Therapy pet should be preferred
over home pet or clinicians own pet for
AAT.
© 2018 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Why this paper is important to pediatric dentists
• AAT can be applied in dental clinics for behaviour
management of children.
• Parents accept the AAT for their children and become
involved in behaviour management.
• The most common pet for therapy of patients in hos-
pitals are dogs and the favourite pet for children is
also dog
Conflict of interest
The rest of the authors declare no conflict of
interests.
Author’s contribution
Dr Nidhi Gupta and Dr Tushar Yadav have
done the work beginning from the planning
to the execution of this study.
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