Proper treatment of the pediatric psychiatric population can be challenging. Emergency department (ED) boarding, availability of child and adolescent psychiatrists, lack of parental understanding, and inexperience working with children with special needs are just some of the obstacles the ED physician will encounter. We discuss the risk stratification and interventions necessary when dealing with children and adolescents presenting with suicidal ideation and violent behavior. In addition, we discuss the unique approaches to patients with autism spectrum disorders and attention deficit hyperactivity disorder.