Management of pain and anxiety for children requiring urgent care has progressed dramatically in the past decade. However, the administration of analgesia and sedation in children is inconsistent, with significant practice variation among practitioners, and especially amid younger children who receive less than optimal analgesia. Nasal administrations of drugs have several significant advantages over current practices. The nose has a very rich vascular supply, it facilitates direct absorption to the systemic blood supply and increases bioavailability of the drug, compared to oral administration. The current review summarizes available information on the use of intranasal drug delivery for children in acute illness. Midazolam (Versed), Fentanyl, Diamorphine and Ketamine are discussed, as well as pitfalls and caveats of intranasal drug use.