Autism spectrum disorder (ASD) is common—affecting approximately 1 in 68 children—and increasingly recognized in pediatric emergency departments (EDs). While we pride ourselves on providing high-quality care for all children, we must acknowledge that the noisy, fast-paced, and unpredictable environment of the ED can be especially distressing for autistic patients. For many children with ASD, the ED is not just unfamiliar—it’s overwhelming.

A study by Nicholas et al. brings forward the voices of parents, ED clinicians, and administrators, and outlines practical steps to make EDs more compassionate and accessible for children with ASD. Here are six key takeaways and what you can do starting today.

Know Before They Go: ASD-Focused Preparedness

Emergency care often begins at triage—but for children with ASD, success may hinge on what happens before that.

What you can do:

  • Implement brief screening tools at registration to identify communication needs, sensory triggers, and calming strategies.
  • Encourage families to bring “All About Me” sheets or care cards that summarize critical accommodations.
  • Digitize and integrate this into your EHR for quick reference.

Manage Wait Times with Intentionality

Long, unstructured waits are hard for all kids—but especially for autistic children who rely on routine and predictability.

What you can do:

  • Offer sensory-friendly spaces or quiet rooms with calming tools like weighted blankets, noise-canceling headphones, or fidget toys.
  • Borrow from the restaurant world: Use pagers or texting systems to allow families to wait in less stimulating environments (e.g., their car).
  • Communicate wait times clearly, and check in often.

Tailor Sedation and Restraint Approaches

Sedation and physical restraint can be traumatic for children with ASD and their caregivers.

What you can do:

  • Ask families what’s worked (or hasn’t) in the past.
  • Discuss options like oral medications, intranasal routes, or the presence of trusted caregivers during procedures.
  • Avoid “default” restraint approaches. Be intentional, and when possible, preventive.

Bring in the Experts: Child Life and Beyond

Developmentally appropriate support is a game-changer—especially during painful or anxiety-provoking procedures.

What you can do:

  • Involve Child Life whenever possible to support procedural preparation and coping strategies.
  • Stock your department with a sensory cart, calming visuals, or social stories to help kids understand what to expect.
  • Orient new staff to these resources early and often.

Build Capacity Across Your Team

We don’t expect every clinician to be an autism specialist—but we can all do better with a little training.

What you can do:

  • Incorporate ASD care into simulation scenarios, staff onboarding, and continuing education.
  • Offer tip sheets on communication strategies, de-escalation, and non-verbal pain assessment.
  • Create quick-access resources (digital or physical) in high-traffic care areas.

Plan for What Comes Next

A visit to the ED shouldn’t be the end of the road—or the start of a revolving door.

What you can do:

  • Partner with outpatient providers to ensure follow-up is arranged for behavioral, medical, or developmental concerns.
  • Work with your hospital’s care coordination team to create pathways for kids with recurrent ED visits.
  • Advocate for transition planning resources as patients age out of pediatric care.

Final Thoughts

Compassionate care for children with ASD in the ED is possible—and necessary. It begins with listening to families, adapting our environments, and equipping our teams. As Nicholas et al. emphasize, “Heightened ASD competence in care may prevent children from being triggered into meltdowns and the need for greater resource infusion.” In short, good care is not just kinder—it’s smarter.

References

Patient- And Family-Centered Care in the Emergency Department for Children With Autism. Nicholas DB, Muskat B, Zwaigenbaum L, et al. Pediatrics. 2020;145(Suppl 1):S93-S98. doi:10.1542/peds.2019-1895L.

Medical Management of Children With Autism in the Emergency Department.. Wolpert KH, Kim SJ, Kodish I, Uspal NG. Pediatric Emergency Care. 2022;38(7):332-336. doi:10.1097/PEC.0000000000002751.

Youth With Autism Spectrum Disorder in the Emergency Department. Lytle S, Hunt A, Moratschek S, Hall-Mennes M, Sajatovic M. The Journal of Clinical Psychiatry. 2018 May/Jun;79(3):17r11506. doi:10.4088/JCP.17r11506.

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