Pediatric Emotional Distress Reference System (PEDRS)

• If parent / caregiver is available and able to respond to your directions, have him/her hold or cuddle the infant during the initial assessment or during medical procedures
• Talk to the infant in a soft, soothing voice
• Gently caress the infant's arms or legs
• Wrap the infant in a blanket
• Provide a pacifier (if you provide one, ask parent permission before giving it to their child)
• Bottle (provided by parent)

• Hold up a stuffed animal / colorful object in the infant's visual field and slowly move it from side to side
• Provide a bottle or pacifier
• Have parent / caregiver talk quietly, using their normal language
• Allow parent / caregiver into the child's visual field
• Talk to infant in a quiet, soothing voice
• Play Peek-a-Boo
• Use mobile device to show on-line videos such as Cocomelon

• Allow caregiver to stay with child when possible.
• Provide a stuffed animal or have parent get the child’s favorite object.
• Talk in a quiet, soothing voice.
• Sing softly.
• Have child sing their favorite song.
• Cover child in a blanket.

• Interactive books/musical light-up toys
• Singing
• Stuffed animals
• Ask caregiver to play a favorite game.
• Give the child a penlight and show them how it works (pretend the penlight is a candle and have the child blow it out).
• Use a puppet to talk to the child or give instructions.
• Talk in a funny voice.
• Ask what sound a  ______ (cat, dog, cow, etc.) makes.

Make sure you choose items that aren’t choking hazards.

• Have the child take deep, slow breaths with you.
• Use a pinwheel or blow bubbles to facilitate deep breathing.
• Ask the child about their favorite toy, stuffed animal, pet, etc. (get specifics such as color, name)
• Let the caregiver hold the child’s hand or stroke their arm or leg.
• Give the child a stuffed animal.
• Ask the child to tell you how to play their favorite game.
• Have the child identify five things they see/hear (make sure the child is in a safe place without distressing stimuli).
• Have the child draw or complete a puzzle.
• Provide simple instructions and realistic choices

• Provide a glitter wand or meteor storm.
• Interactive book/musical light-up toys
• Have the child sing to you.
• Show the child how to use a kaleidoscope.
• Give the child a job — something simple they can do.
• Give a stuffed animal, have the child name it, tell a story  about where it came from, wrap it in a blanket, etc.

Make sure you choose items that aren’t choking hazards.

• Deep breathing (in through nose, out through mouth)
• Ask the child if they would like a stuffed animal.
• Squeeze a stress ball.
• Plastic slinky
• Play I-Spy.
• Ask the child what they do to calm down when upset.
• Give the child a Koosh ball, tangle, or fidget spinner.
• Let the child listen to music on their phone (provide headphones if needed).
• Provide simple instructions and realistic choices
• Have the child identify five things they see/hear and explain that this helps calm their body down (Make sure the child is in a safe place without distressing stimuli)
• Provide simple instructions and realistic choices
• Let the child know that is is normal to feel scared, stressed worried.

• Glitter wand/items floating (Use I-spy or ask what they see floating)
• Meteor Storm
• I-Spy
• Listen to music on their phone/play video game
• Kaleidoscope
• Give the child a job — something simple they can do
• View Master
• Seek and Find/20 Questions/Where’s Waldo

• Ask the child what they do to calm down when upset.
• Let the child listen to music on their phone (provide headphones if needed).
• Have the child focus on you and do deep abdominal breathing (in through nose, out through mouth).
• Tangle/sensory item
• Koosh ball/stress ball (brain shape works well)
• Texting (see distraction box for guidelines)
• Ask questions about the child’s favorite activities.
• Five things the child sees/hears/touches-feels (make sure child is away from distressing stimuli and explain how this helps calm their body
• Let the child know that it is normal to feel afraid, stressed, or worried.
• Provide simple information about what you are doing and why you're doing it
• Give realistic choices

• Let the child listen to music on their phone (provide headphones if needed).
• Allow the child to text friends.
  • No pictures; ask about who/what they are texting; discontinue if it becomes disruptive/distressful; do not allow if event could be reported on news or involved fatalities.
• Watch a video or play a game on their phone
• Fidget spinner or tangle
• Seek and Find/20 Questions/Where’s Waldo (younger adolescent)
• Have child tell you about his/her favorite movie/pet/sport, etc.
• Koosh/stress ball

• Ask the caregiver to look at you and take deep, slow abdominal breaths (in through nose, out through mouth).
• Touch or gently hold the caregiver’s forearm between wrist and elbow (ask permission).
• Give the caregiver something to hold — pen, koosh ball, stress ball, paperclip, anything handy.
• Have the caregiver close their eyes and describe the feeling against their skin — ground, breeze, etc. (Avoid this activity unless removed from any distressing stimuli.)
• Let the caregiver know that it is normal to feel afraid and concerned.
• Provide simple information about what you are doing and why you’re doing it

• Ask the caregiver for information that you need to better help the child.
• Ask the caregiver to retrieve a favorite object that comforts their child.
• Ask the caregiver how they comfort and calm the child.
• Give the caregiver a task or job to do.
• Have the caregiver fill out a form with personal and medical information about the child (even if it is not required).
• Ask if there is someone the caregiver would like to call (or have you call) for support.
• Give the caregiver a role in the child’s care.