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Introduction The necessity for procedural sedation during hydrostatic reduction for ileocolic intussusception in children is being debated. This study aimed to compare outcomes of procedures with and without sedation, as well as parental preferences.Methods This retrospective study (2019–2021) reviewed the medical records of children treated for ileocolic intussusception at two hospitals—one that did not provide sedation (non-sedation, NS) and one that did (with-sedation, WS) during hydrostatic reduction. The primary outcomes encompassed success rate, perforation, and recurrence. Parental satisfaction was assessed using a 5-point Likert scale questionnaire.Results Data from 65 children were included: 42 in the NS group and 23 in the WS group. The hydrostatic reduction success rates were 79% (NS) and 74% (WS) ( p=0.670). One colon perforation occurred in each group (p=0.661). Recurrence rates were 14.3% (NS) and 17.4% (WS) (p=0.740). The questionnaire response rates were 48% (NS) and 57% (WS). Of the NS parents, 75% (15/20) were (very) satisfied with the procedure, compared with 85% (11/13) of WS parents (p=0.196). Ten (50%) NS parents would have preferred sedation, while 46% (6/13) of WS parents would have preferred to be present during the procedure.Conclusions There were no significant differences in success rates, complications, or parental satisfaction between procedures performed with or without sedation during hydrostatic reduction. Effective pain management and a comforting approach are crucial for stress reduction. Shared decision-making with parents regarding the pros and cons of sedation is recommended.