Remember, kids ARE just little adults: they feel pain just like the bigger people!
Don't let others convince you not to consider pain management for simple procedures because it is more convenient.
ORAL SUCROSE
Proven to reduce signs of distress in neonate (<1 month) for minor, painful procedures
Use in combination with sucking (ie, a pacifier).
Dose: 0.1ml of 24% to 2ml of 50% sucrose.
Topical Lidocaine Creams (LMX 4, EMLA)
Use for IV insertion (several studies has proven skilled triage nurses ar able to predict which children will need IVs)
Use for Lumbar Puncture!
Normally you most likely either ask someone with large muscles to hold the kid or you inject lidocaine, which can obscure your landmarks.
Instead, place LMX4 (takes ~20minutes to produce numbness) while you are documenting, getting consent, and setting up your equipment.
This will give good anesthesia and keep the kid comfortable (ie, still) and not distort your landmarks... making you more likely to have success.
In neonates, you can also use Oral Sucrose Pacifer for added benefit.
References
EMSC Panel (Writing Committee) on Critical Issues in the Sedation of Pediatric Patients in the Emergency Clinical policy: Critical issues in the sedation of pediatric patients in the emergency department. Ann Emerg Med. 2008 Apr;51(4):378-99, 399.e1-57
