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Background Acute Behavioural Disturbance (ABD) is a critical clinical presentation characterised by severe agitation, persistent physical activity, and tactile hyperthermia. Prompt recognition and intervention are essential to prevent metabolic crisis and cardiovascular collapse. Rapid tranquilisation, particularly with intramuscular (IM) ketamine, has emerged as a key strategy in managing severe ABD, offering both physiological stabilisation and protection from harm. While ketamine’s effectiveness in adult populations is well-documented, its safety profile in paediatric patients remains less clear, prompting this scoping review.Methods This review explores the safety of IM ketamine for sedation in paediatric patients (<18 years) presenting with ABD in emergency and prehospital settings. A systematic search of PUBMED and CINAHL databases was conducted using terms related to paediatrics, ABD, and ketamine. Inclusion criteria focused on original studies reporting safety outcomes following IM ketamine administration in acute care settings.Results Three retrospective studies met the inclusion criteria. Hopper et al. (2015) reported no major adverse events in a small cohort including paediatric patients. Sandoval et al. (2023) found a low incidence of serious adverse events in a large prehospital cohort, with 99% not requiring airway intervention. Bourke et al. (2023) similarly reported no serious adverse events in 152 paediatric cases.Abstract PP39 Figure 1Conclusion Findings suggest IM ketamine is a relatively safe and effective option for managing paediatric ABD in acute settings. However, concerns remain regarding its use in very young populations, particularly in light of local discussions. Further research is needed to refine clinical guidelines and ensure optimal safety in this vulnerable group.