Introduction Procedural training is a universal concern amongst pediatric residents and their teachers. We developed and implemented formative assessments to generate direct and indirect procedural feedback. We analyzed changes in residents’ perceived procedural knowledge, skills, confidence, and entrustment. Methods Senior pediatric residents rotating in the pediatric emergency department participated in video-recorded formative assessments of informed consent OSCEs and simulated toddler forehead laceration repair and infant lumbar puncture. Residents reflected on their perceived procedural knowledge, skills, confidence, and entrustment through Likert and entrustment scales. Secondary outcomes of formative assessment completion rates and proportions of procedures performed by pediatric residents tracked feasibility and potential clinical impact, respectively. Results Including the pilot period, 89% of residents (31 out of 35) received direct and indirect procedural feedback. Perceived composite competency and entrustment improved for laceration repair (competency: from 3.1 to 3.9, p < .001; entrustment: from 4.0 to 5.1, p < .001) and lumbar puncture (competency: from 3.5 to 4.0, p < .001; entrustment: from 4.6 to 5.6, p = .001). We observed an increase in the proportion of clinical laceration repairs (11% [97 out of 885] vs. 23% [218 out of 946], p < .001) and lumbar punctures (23% [12 out of 54] vs. 41% [21 out of 52], p = .05) performed by pediatric residents. Discussion Integrating feasible procedural formative assessments into the pediatric emergency department rotation had a positive impact on senior pediatric residents’ perceptions of their procedural knowledge, skills, confidence, and entrustment and was associated with increased procedural engagement.