Humane restraint and behavioural support in emergency care

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Target exams

Red flags

• Agitation in a child with fever, abnormal observations, focal neurological signs, pupil changes, abnormal movements or fluctuating consciousness is medical or toxicological until proven otherwise
• A bedside glucose must be checked in any agitated child with altered consciousness; hypoglycaemia is the most reversible and most missed cause
• Combining intramuscular olanzapine with a parenteral benzodiazepine in the same visit risks severe respiratory depression, hypotension and airway loss; the FDA has warned against this combination without close monitoring
• A child held face-down, in a hobble restraint, or with airway obstruction during restraint is at risk of positional asphyxia and sudden death; the airway must be visible and protected at all times
• Droperidol and haloperidol prolong the QT interval; an ECG is required with cardiac history, electrolyte disturbance, other QT-prolonging drugs, methamphetamine intoxication or high cumulative doses
• Antipsychotic-naive children have a high rate of extrapyramidal, sedation and metabolic adverse effects; start low, titrate, and monitor
• A restrained child is a vulnerable child; an automatic safeguarding review is required for any child in care and for any unexplained or repeated restraint
• Oversedation, rising respiratory rate falling, falling oxygen saturation or unable to maintain airway after sedation means call senior, PICU or retrieval now

Life stages

Care settings

Clinical exam formats

Board mappings

• Acute Care
• Behavioural and Mental Health
• Current 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young person
• Current 2026 PREP curriculum — Learning Objective 2.2.2: Perform comprehensive and accurate clinical assessments
• Current 2026 PREP curriculum — Learning Objective 2.2.3: Perform acute resuscitation and advanced life support
• Current 2026 PREP curriculum — Learning Objective 2.4.7: Assess and manage common behavioural, developmental and mental health presentations in infants, children and young people
• Current 2026 PREP curriculum — Learning Objective 2.5.2: Practise with a commitment to child protection, advocacy and the United Nations Convention on the Rights of the Child
• Renewed curriculum for first-year trainees from 2027 — Learning goal 11: Acute care and procedures
• Renewed curriculum for first-year trainees from 2027 — Learning goal 17: Acute care
• Clinical Applications
• Medical Sciences
• Ethics and Law
• Long Cases
• Short Cases
• Communication
• 3. Professional skills and knowledge: Clinical procedures
• 4. Professional skills and knowledge: Patient management
• 6. Leadership and team working
• 7. Patient safety, including safe prescribing
• 8. Safeguarding
• 9. Equality, diversity and inclusion
• Mental Health: Assesses and manages children and young people presenting with acute behavioural disturbance, self-harm or mental health crisis
• Neurodisability: Manages acute behavioural disturbance in children with autism, intellectual disability or complex neurodisability
• Foundation of Practice (FOP)
• Theory and Science (TAS)
• Applied Knowledge in Practice (AKP)
• Clinical
• History
• Video
• General Pediatrics Content Outline — Domain 7: Emergency and Critical Care
• General Pediatrics Content Outline — Domain 10: Behavioural and Mental Health
• General Pediatrics Content Outline — Universal Task 1: Physiology and Pathophysiology
• General Pediatrics Content Outline — Universal Task 3: Diagnosis
• General Pediatrics Content Outline — Universal Task 4: Management and Treatment
• General Pediatrics Content Outline — Universal Task 6: Professional Conduct, Ethics, and Legal Principles
• General Pediatrics EPA 7: Recognizing a Severely Ill Patient, Providing Initial Management, and Mobilizing Resources Needed for Continued Care
• General Pediatrics EPA 12: Assessing and managing children and adolescents with behavioural and mental health concerns
• Patient Care 3: Organize and Prioritize Patient Care
• Patient Care 4: Clinical Reasoning
• Patient Care 5: Patient Management
• Interpersonal and Communication Skills 1: Patient and Family-Centered Communication
• Interpersonal and Communication Skills 2: Interprofessional and Team Communication
• Professionalism 3: Ethical Principles
• Systems-Based Practice 1: Patient Safety
• Medical Expert
• Communicator
• Collaborator
• Health Advocate
• Pediatrics: Foundations EPA #1 — Recognizing deteriorating and/or critically ill patients and initiating stabilization and management
• Pediatrics: Core EPA #2 — Resuscitating and stabilizing critically ill patients
• Pediatrics: Core EPA #9 — Assessing and managing children and youth with mental health and behavioural concerns