BACKGROUND: Restraint is sometimes necessary to successfully perform procedures on pediatric patients in the emergency department. A papoose may be intimidating and uncomfortable, and a wrapped sheet may not keep the child's arms from wiggling free. DISCUSSION: We present an adaptation of the wrapped sheet (burrito) technique, using a pillowcase to better immobilize the child's arms. The arms are inserted in the pillowcase behind the child's back, and then the child is placed supine over a horizontally placed sheet and turned to each side so the sheet is tucked behind the back. The child is thereby easily and comfortably restrained. CONCLUSIONS: We believe this technique more successfully restrains the child than the wrapped sheet alone, and is easier to execute than other wrapped sheet techniques aimed at improving arm immobilization.
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