- The sick child deteriorates with handling and distressing procedures.
- Increased distress in an unwell child can

• Increase heart rate, respiratory rate and blood pressure
• Cause de-oxygenation (especially in neonates)
• Tip a child's condition from moderate to severe

- Minimal handling is particularly important in:

• Respiratory conditions, such as croup, asthma

Principles:

• Keep the child with parent or care giver.
• Try and keep the environment quiet and moderate lighting.
• Allow the child comfort feeds if safe to do so.
• Minimise interventions, including examination and investigations that are not going to impact acute management
• Group cares - eg observations and oral medications
• Use comfort techniques for painful procedures such as intravenous catheters - EMLA or Angel cream, distraction
• Don't forcibly alter a child's posture - especially in respiratory conditions such as croup. Children will naturally adopt the posture that facilitates the least airway obstruction.