children are generally in the visual distractor group, something they can see and/or grasp will provide the highest likelihood of successful distraction During medical and trauma resuscitation or other acutely life-threatening situations, ED staff should strive to provide a professional staff member to support the family and to address questions in an ongoing fashion This will allow the medical team to concentrate on the acute care needs of the child while still supporting the family through this difficult situation For patients requiring pharmacologic sedation, caregivers should be informed about expected responses based on the patient’s developmental level, potential effects of sedation, the purpose of monitoring equipment that will be attached to their child, and any anticipated discomfort subsequent to the procedure The assurance that use of these medications can increase safety and may minimize repeated discomfort should be emphasized The medical team should consider whether the ED is the appropriate venue in which to perform the procedure Collaborative discussion with the care team prior to presenting options to the family may be beneficial Points to consider include the developmental assessment of the child, the anticipated length of the procedure, positioning and management of patient movement, and the need for pharmacologic interventions Lengthy procedures or a procedure in a patient with a significant inability to cope may deplete resources and might be more safely performed in the operating suite Consequences and complications of the procedure should be anticipated prior to commencing, with mitigation plans in place as needed, particularly in medically complicated or high-risk patients Aside from procedures necessary to address immediately life-threatening emergencies, assent and support for the procedure should be sought from the child and parents beforehand An informative, efficient discussion of risks, benefits, and alternatives almost always reassures the parents of the need for the procedure Written consent may not be necessary for simple procedures, but standards should be explicitly defined by local ED clinical leadership and hospital policies around which procedures require written consent, what defines an emergency during which written consent can be bypassed, and under what conditions a minor should also assent Finally, prior to initiating a procedure on any patient the use of a team time-out before starting should be promoted as part of the ED safety culture Use of a checklist during the time-out can ensure that the correct procedure is being performed on the correct patient at the correct anatomic location and that adequate supplies are available for the procedure POSITIONING AND RESTRAINTS