Pediatric anxiety during cast room procedures is common and various methods to manage distress may be used. Certified Child Life Specialists (CCLS) are formally trained professionals with proficiency in helping children during taxing events. The utilization of a CCLS has not been well documented in a pediatric orthopedic cast room. The aim of this study was to assess the impact of a CCLS in this setting through a prospective randomized trial. 86 children, age range 2–10 years, who underwent cast room procedures were randomized: group I (42 children) had a CCLS present during their procedure. Group II (44 children) did not have a CCLS present during their procedure. Procedures included cast removal/placement, fracture manipulation, and pin removal. We calculated change in heart rate as beats per min (bpm) during various stages of the visit and a subjective behavior score evaluating behaviors, score range −3 to 3. There was no significant difference in the demographics and age between groups. The mean behavior score for group I was 1.78 versus 1.04 in group II (P<0.001). The change in heart rate recorded showed an increase by 7.5 and 9.3 bpm in groups I and II, respectively (P=0.829). CCLS Therapy significantly affects the observed behavior score of children undergoing a procedure in a pediatric orthopedic cast room. A greater increase in heart rate was observed as a trend in those children treated in the absence of a CCLS. The presence of a CCLS appears to positively affect the cast-room experience for children and their caregivers. Level of Evidence: Level II – Therapeutic Randomized-Controlled Trial.