This prospective multicenter observational study sought to quantify the risk of procedural sedation in children, in whom sedation is much more commonly used than in adults. The participating institutions voluntarily submitted data on more than 30,000 encounters and found that the overall risk of serious adverse events was much lower than that seen in a prior single-center study. However, adverse events with the potential for harm (near misses), such as unanticipated need for bag-mask ventilation or reversal of anesthesia, occurred in 1 of 89 cases. The authors note that, owing to the voluntary nature of the database, these data may be closer to "best practice" than the typical community experience.