There have been real advances in the area of pain and anxiety management in pediatric patients in the urgent and emergent settings. The focus on the ''patient experience'' and not just the obtaining of a diagnosis and a treatment has forced many Emergency Departments to reassess how they address pain and anxiety. Many new products and methods, whether pharmacological based or not, are being utilized to make the patient encounter less stressful and less painful for both children and families. Additionally, it has been recognized that appreciating the importance of the patient's developmental age is essential in choosing the correct modality of intervention. Yet again, we learn children are not just small adults.