The demand for procedural sedation is increasing in children of all ages who due to anxiety, medical need or the requirements of the intervention or investigation need a periprocedural plan consisting non-pharmacological and pharmacological approaches. While paediatric procedural sedation is practised by many medical and nursing specialists, for varied indications and in differing hospital locations it remains the responsibility of anaesthetists to have a comprehensive understanding of this discipline in order to advance this field and maintain safety standards. In the past decade, guidelines have been developed to ensure that children who undergo sedation are managed by clinicians who can competently assess their needs, take informed consent and plan and deliver a safe and effective sedation strategy in multiple scenarios, such as for painless imaging, painful procedures, dentistry and endoscopy. Recent updated fasting guidelines which are less restrictive means that children will be hydrated, less irritable and more stable when sedated. The drug dexmedetomidine and its extremely favourable respiratory profile and low rate of airway and respiratory complications have changed the face of sedation for painless imaging and are allowing a greater range of children to have these procedures without the need for general anaesthesia. The field of procedural sedation for children is rapidly growing in popularity amongst both clinicians and patients, and it is therefore vital for paediatric anaesthetists to stay up to date and aware of guidelines and advances.