Fear and loathing in the ER: managing procedural pain and anxiety in the Pediatric Emergency Department.

The pediatric emergency department can be frightening for children. Visits are unplanned, and frequently accompanied by significant emotional and physical distress. While treatment of pain and anxiety in children have been historically inadequate, the barriers to their treatment have largely been overcome through increased awareness, child- and family-focused care, standardized assessment, institutional safety protocols, and newer pharmacologic agents. The pediatric emergency physician is now a primary advocate for treatment of children's pain and anxiety and for the safe and appropriate use of procedural sedation. This article focuses on the treatment spectrum available for providing safe and effective procedural sedation, analgesia and anxiolytic therapy.