Emma is so young that it has to be her parents and the nurse who cooperate to make the procedure as easy as possible for her. 
As Emma is aware of what is going to happen from the very moment she gets to the consultation room, her parents have learned that the procedure has to be performed as quickly as possible. 
To make the suctioning tube bother Emma as little as possible, her head and arms must be fixed and slightly bent upwards to avoid her pulling the tube. 
It is not very nice, so everything is ready to start the procedure before Emma is fixated. 
It appears violently and she is fighting it. 
Her parents support her splendidly. They are very attentive and immediately after the procedure ready to comfort with toys and her dummy. 
It only takes a few minutes before Emma stops crying and feels better willing to eat raisins. 

Comments/considerations: 

It is a healthy and necessary reaction that Emma is protesting.. It would be more extraordinary if she did not. 
If Emma went happy into the consultation room, you might choose to make the tracheal suctioning at the end of the consultation. 
If Emma only came with one of her parents or if one of her parents would not like to fixate her, it is always possible to call a nurse for assistance. 
With small children it is a good idea to make the tracheal suctioning before breastfeeding or bottle feeding as the procedure may provoke vomiting. 
We use sugar water (1%) as a pain-reliever in babies from 0 to 6 months - and offer e.g. raisins/fruit gum afterwards from the age of 1 year if the parents permit it. 
If the parents do not permit this, we ask them to find or bring something that they know will comfort the child (dummy, soft toy, fruit-bar etc.). 
If the parents would not like to fixate their child, it is our job to talk with them and try to help them. We try to find a space to talk without the presence of the child or we talk on the phone. 
Often it will be “educational” for the parents to try a tracheal suctioning themselves. We have learned, that it will often be a great help both for the parent and the child to see that the parents are ready to try and able to cope. 

From the age of 2 – 4 years, children are able to understand simple explanations about why they need tracheal suction; as soon as you experience the very first sign of this, it is a matter of seizing the opportunity and begin to involve the child in the cooperation. You can start by offering simple options (e.g.do you want to sit with mum or dad today? /Am I going to count to 2 or 3 today? Never expect or ask for too much, but know that the child cooperates as good as possible. Always praise and try to build up confidence; take time afterwards to allow the child to react, talk about it and do something nice.