The present study assessed behavioral distress during noninvasive outpatient procedures in children ages 4-10 years using a multimethod approach. Factors hypothesized to exacerbate children's distress included parents' and children's attitudes toward healthcare, children's knowledge of medical settings, and parental anxiety. A total of 53 parent-child dyads were recruited from outpatient clinics, with procedural distress assessed via child report, parent report, and direct observation. Some differences emerged depending on the method used to gauge distress. Children's healthcare attitudes and knowledge were associated with observed and child-reported distress, but parent's personal anxiety was associated only with their own perceptions of children's procedural distress. Parents' attitudes toward healthcare were associated with their anxiety but not with children's behavioral distress or healthcare attitudes. Findings are discussed in terms of more consistent findings regarding children's healthcare knowledge and attitudes versus the potential need for additional research on more divergent findings regarding parents' anxiety and healthcare attitudes. © The Author 2011 . Published by Oxford University Press on behalf of the Society of Pediatric Psychology.