Procedures on children

I'm a podiatrist in the United States and sometimes other people refer to me tiny children [ toddlers or less] to do procedures on, such as infected nails or things stuck in the foot. The older children I usually can do local anesthesia before I do things, but the small ones it usually tends not to work ( guarding,pulling,having the parent hold them down, etc)

What suggestions do you all have for when trying to get pain control prior to procedures? Or should I send them to an ED or somewhere where they can sedate children