1. The provider's decision to insert a needle is determined as part of the patient's standard care for the diagnosis or treatment of illness. A standard history and physical examination will be performed by the ED physician/nurse and includes information sufficient to determine patient eligibility. All children undergoing needle insertion will be assessed for eligibility by a trained provider based on information routinely documented (see above Inclusion/Exclusion Criteria). Children eligible to receive EMLA cream will be excluded and will receive EMLA cream routinely. Other anesthetics or analgesics will not be withheld from any patient enrolled in this study. The standard pre-procedure preparation time will provide an appropriate time period to educate the patient and parent about the study and obtain consent. This process will not delay the patient's care. Standard non-pharmacologic emotional support and explanations will be provided to the patient and/or parent.