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The objectives of this study were to measure noise levels in a tertiary care pediatric emergency department (ED) and to identify attending staff physicians' and first-year residents' perceptions of background noise levels and its impact on communication and teaching.A mixed methodology was used in this study. A sound level meter measuring 30 to 140 dB was placed in the ED for a week. All consenting staff physicians and first-year residents were surveyed using a semistructured questionnaire during the study period to assess their perceptions of background noise and its impact. Descriptive statistics were used for quantitative analysis. Narrative answers were coded and analyzed using the method of meaning condensation to assess the impact of background noise on both communication and teaching.The average noise level in the ED is 68.73 dB for a 24-hour period. The number sound peaks higher than 80 dB, with an average of 309 dB/d (minimum, 193 dB; maximum, 461 dB). Only 35% of staff physicians' surveys and 22% of residents' surveys identified the noise levels to be uncomfortable. However, background noise in the ED was perceived as stressful, affecting interaction, communication, and teaching between residents and staff physicians. Staff physicians and residents stated that they feel helpless when it is too noisy and did not have good strategies to reduce background noise in the ED.The high background noise levels in a pediatric ED are perceived as stressful and interfering with communication and teaching. Noise levels in EDs should be measured, and noise reduction strategies should be implemented because physicians are not consistent in identifying excessive noise levels.