<p>Acute pain is one of the most frequent reasons for pediatric patients to visit emergency departments, yet it continues to be often inadequately treated. Reasons for this include a&#xa0;lack of training, lack of routines and lack of standardized procedures. Inadequately controlled pain leads to anxiety, reduced cooperation, subsequent avoidance behavior and potentially chronic pain conditions. The aim of this article is to present established strategies for acute and procedural pain management in pediatric emergency departments, including evidence-based pharmacological and nonpharmacological measures. Nonopioid analgesics form the basis of pharmacotherapy, with oral administration being preferred. Opioids are used early on for severe pain; nasal administration of fentanyl in particular enables rapid onset of action and has become established due to its safe application profile. Combination treatment increases the effectiveness and reduces side effects. Painful procedures, such as needle punctures, repositioning or wound care require age-appropriate analgesia and anxiolysis. Nonpharmacological measures, such as distraction, comfort positioning and child-friendly language effectively reduce anxiety and pain and are an integral part of treatment. Pharmacological measures such as topical anesthetics should be used as a&#xa0;supplement. For short, painful procedures, nitrous oxide (N₂O/O₂), midazolam, or esketamine are viable options. Systematic pain management improves treatment outcomes, cooperation, team organization, patient safety and the satisfaction of patients, parents, and healthcare professionals. Interdisciplinary standards, guidelines, dosage aids and early preparation are essential.</p>