BACKGROUND Pain perception in young children did not receive much attention as there are concerns regarding the safety of administering potent opiates and sedatives. Moreover, we often consider that it is natural for children to cry in such situations and young children won't complain about pain. Midazolam is a short-acting benzodiazepine with rapid onset of action and is one of the most widely used sedatives in intensive care unit. The intranasal route avoids the need for intravenous access, avoids the pain of the parenteral injection, and is easily accessible for drug administration. The aim of this study is to compare the safety and efficacy of intranasal midazolam against intravenous midazolam for paediatric procedural sedation. MATERIALS AND METHODS This prospective study was conducted in Paediatric ward, IMCH, Medical College, Kozhikode from June 2015 to May 2016. 128 children between 3 and 12 years requiring a diagnostic lumbar puncture were included. They were divided into 2 groups A (Intranasal) and B (Intravenous) by random allocation. Statistical analysis was performed using statistical package for social sciences 16.0 (SPSS 16.0) statistics analysing software. RESULTS The deviation of heart rate from baseline during procedure is significantly more in intravenous group with t (116.345)= 2.354, p= 0.020 & also the deviation of heart rate from baseline at the end of procedure was significantly higher among intravenous group with t (103.974)= 4.593, p= 0.000. The deviation of diastolic blood pressure during procedure from baseline is significantly higher among the intravenous group with t (102.521)= 4.535, p= 0.000 & also the deviation of diastolic blood pressure from baseline to the end of procedure was significantly higher among the intravenous group with t (126)= 4.819, p= 0.000. The sedation achieved during the procedure is comparable between the two groups with a p value of 0.225. The intranasal group took longer time to achieve adequate sedation as well as for recovery. But there were no serious adverse effects. CONCLUSION Intranasal midazolam is safe and effective for paediatric procedural sedation and is associated with lesser variability in heart rate and blood pressure in comparison with intravenous midazolam.