CHAPTER 130 ■ PROCEDURES THERESA M FREY, MATTHEW R MITTIGA PREPARATION AND ASSESSMENT OF THE CHILD A significant challenge to the effective and efficient performance of procedures in pediatric emergency department (ED) patients is the fear and anxiety generated in both children and their caregivers at the prospect of potentially painful procedures Even when pain can be well controlled, fear can derail even the simplest of procedures Optimal preparation and assessment of the child and their caregivers can allay fears and anxiety and contribute to procedural success and a positive patient and family experience Even relatively short procedures can become prolonged and difficult to successfully complete without accurate assessment and optimal preparation Certified child life specialists are experts in this preparatory/assessment role and have been increasingly used as part of the care team in EDs with significant pediatric patient volumes In the absence of a child life specialist, ED staff should be prepared to provide the needed preparation, support with positioning, and distraction techniques to increase the probability of success The child’s developmental maturity and coping skills should be assessed to determine the capability for understanding, tolerating, and cooperating with the procedure Key considerations for successful preparation of the child and their caregivers include (1) a developmentally appropriate explanation of the procedure using hands-on methods when possible, including pretend medical equipment and models (e.g., dolls); (2) honesty with the child and caregivers about the painful portions of the procedure with details regarding the planned behavioral coping strategies to be employed during the procedure; (3) encouragement of questions about the procedure; and (4) assessment and intervention for parental anxiety, which easily transfers to the pediatric patient if not addressed Pain management and coping strategies might include swaddling or oral sucrose in younger infants and breathing techniques, distraction, and visual imagery in preschool and school-aged children Children are less fearful and distressed when in a sitting position than in a supine position Positioning a child in a caregiver’s lap can be beneficial if the procedure allows Potential distraction items include bubbles, toys that light up, books, videos, conversation with the child, and mobile devices with age-appropriate applications Since younger