Assessed the influence of adult in-session behavior and psychological variables on 77 preschool children's coping and distress during routine immunizations. Maternal anxiety was not related to the behavior of the parent, staff, or child. However, in-session behavior by one person was highly correlated with in-session behavior by the other people in the treatment room. The effects of parent and staff in-session behaviors, previous child medical experience, and maternal anxiety on child distress and coping was examined using hierarchical multiple regression procedures. Child coping was predicted by parent and staff behavior whereas child distress was predicted by parent behavior and by the level of the child's distress during previous medical and dental experiences. Implications for intervention and future research are discussed.