Try non-pharmacological approaches

Whether or not conscious sedation is used, distraction techniques can help children tolerate procedures. "Distraction can help kids stop worrying about the laceration on their forehead so the procedure goes much more smoothly," says Francis Damian, MS, RN, director of nursing and patient services at the ED at Children's Hospital in Boston. "That works better than the traditional method of telling them everything, which frightens them to death."

Follow diversion techniques through. If you decide to try a distraction technique, you need to follow it through, stresses Damian. "You need to be vigilant and stay on top of it through the entire procedure," she says. "Once you start talking to the child, you have to continue. And, if you have them falling asleep, you need to make sure no one comes in and blows it."

Make the room as calming as possible. "We decrease stimulation as much as possible, which includes dimming the lights," says Lynn Daum, RN, an emergency nurse at Children's Hospital Medical Center in Cincinnati, OH. Tape recorders are mounted on the walls of the treatment room so that soothing music can be played.

Consider the child's age. Diversion techniques should be tailored to the child's age. "For older kids, we'll read a book to them or do a sing-along, which takes their mind off what's going on," says Steven Weber, RN, CEN, CFRN, MICN, manager of the children's ED at WakeMed in Raleigh, NC.

Younger children respond better to visual stimulation, such as an hourglass with colored patterns of sand. "We also play Disney songs and environmental music, like relaxing waterfalls," Weber says.

Don't cover up the child's face during procedures. "Children may have a fear of not being able to breathe, which will add to their anxiety," says Weber. "You can shield them adequately to provide a sterile field, but keep eyes and mouth open so they can talk and their field of vision is not occluded."

Ask the child to visualize. For older children, imagining a pleasant experience can reduce anxiety. "Ask children to think of something that makes them feel comfortable, such as petting their animal, being on the beach with the sun hitting them, or playing with their favorite toy," Weber suggests.

Encourage parents to distract, but not restrain. Parents often know the best ways to distract their child, but shouldn't assist in holding them down during procedures. "We try not to have the parents to hold the child down, so their role is a safe, neutral person," says Weber.