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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