Variations in the use of as-needed sedative and analgesic medications may be related to provider biases, nonstandardized assessment, time of day,ambiguous definitions and expectations, level of provider experience, unit structural issues, and cultural beliefs. Patterns of use for as-needed sedative and analgesic medications are relatively understudied. In a report by Dasta and colleagues, more than 40% of as-needed sedative or analgesic order did not have adequate direction or indications. One of the earliest reports of as-needed sedation practice demonstrated important variation in nighttime as-needed sedative practice, depending on the unit structure. Nearly 2 decades later, literature describing the epidemiology of as-needed sedative and analgesic drug usage in children is lacking.