Indications Restraint should be considered in the performance of those procedures in which excess movement will be detrimental to the safe and successful completion of the procedure Excess movement can lead to patient or medical provider injury, prolonged procedural time, and suboptimal procedural outcomes Physical restraints can be more effective than human restraint and may be necessary in a small proportion of infants, toddlers, and preschool children However, restraint may also carry its own share of psychosocial complications, including increased distress, decreased coping, and lasting memories The risks and benefits of restraint, as well as alternatives, should be weighed appropriately In conjunction with restraint, standard methods of pharmacologic anxiolysis or sedation and local or regional anesthesia are often indicated The use of anxietyreduction techniques by trained staff, typically child life specialists, as well as the continued calm presence of the parents, may be of great benefit to the child Complications Erythema, bruising, or edema at points of contact Vascular compromise (restraint too tight or restraint for excessive time) Mistrust and fear at future medical encounters Airway compromise or musculoskeletal injury (rare except in high-risk patients or with unsafe restraint practice) Procedure With good distraction and creative positioning, some children will be able to complete procedures without physical restraint Use the examination prior to the procedure and the period of cleaning and other involvement with the injury to determine how well the patient may tolerate the procedure If the child is able to remain still during these times, you may be able to avoid restraint altogether By placing a sheet under the child prior to commencement of the procedure, you can start with the least amount of restraint, but move to the bundling wrap quickly should it become necessary Positional Support by Caregiver Often, the separation from a caregiver may evoke a response that sets the procedure on a difficult course Child life and other staff may encourage close positioning of the caregiver (i.e., in the bed next to the child or a chair next to the bed) so that the child feels more connected and safe during the procedure Caregiver presence is often associated with decreased stress, less pain, and