increased coping ability in children In addition, caregivers want to be present and report less anxiety when in attendance for invasive procedures Restraint by Personnel Various methods can be used to restrain children for simple emergency procedures as listed above Often, a single assistant can minimize movement of a child The specific positioning for procedures is illustrated with individual procedures The assistant’s hold must be firm enough to prevent movement that would make the procedure more difficult to perform or more likely to induce complications Though uncommon, the use of excessive force may cause superficial or more serious injury With thorough assessment by the care team, careful preparation and attention to distraction, procedures can be very successful with minimal restraint in a cooperative child Bundling Wrap This is an alternative gentle restraint for use during emergency procedures With this, the practitioner can easily access the head as well as upper and lower extremities This method can help infants feel secure and can keep younger toddlers less mobile Leaving one arm/hand out of the wrap for a parent to hold can make the wrap feel less restrictive as well as increase comfort through parental contact and give the patient an opportunity to hold or touch a distraction item Older children will generally not tolerate this wrap very well and other methods should be considered In some settings, using the bundling wrap inside of a papoose (see below) is an acceptable alternative An injured extremity can be left out of the wrap for better exposure Fold a bedsheet on itself so that the width measures from the axillae to the heel of the child Stand the child on the bed and place the bedsheet behind his/her back, under the axilla, and in front of the arms as in Figure 130.1A , with the short end of the sheet tucked behind one arm around the child’s back With the child standing, wrap the long end of the sheet on the child’s other side, around the back to the front and across the trunk again, finishing behind the child, as in Figure 130.1B Lay the child supine or prone to best expose the injury to be treated Papoose Figure 130.1C depicts an example of a papoose, which can be used as a last resort for restraint during repair of lacerations and other wounds It is generally used to expose the head, face, and extremities to maximize efficiency With increased child life presence and staff support and education, many centers have