Objective <p>Although minimal sedation with midazolam is frequently performed in the pediatric emergency department (ED) for various procedures, limited research exists regarding its safety profile, and no clear guidelines define the resources required for minimal sedation. The main objective of this study was to determine the proportion of children who developed adverse events after receiving oral or intranasal midazolam for minimal sedation in our pediatric ED.</p> Methods <p>We conducted an observational, single center study including all children who presented to the pediatric ED between January 1, 2015, and December 31, 2021, and underwent minimal sedation with oral or intranasal midazolam.</p> Results <p>A total of 2544 children with a median age of 4&#xa0;years (IQR 2–6&#xa0;years) were included. We identified a total of 12 (0.47%) adverse events: 9 (0.35%) minimal, 2 (0.08%) minor, and 1 (0.04%) moderate. There were no sentinel adverse events. All children were discharged home from the pediatric ED, and none required hospitalization.</p> Conclusion <p>The incidence of adverse events during minimal sedation with oral or intranasal midazolam in our pediatric ED was low, and interventions were rarely required. Minimal sedation with oral or intranasal midazolam appears to be a safe and well-tolerated procedure. Our findings support the safety of minimal sedation with midazolam in a structured, well-monitored ED setting.</p>