"Chemical restraint" (CR) is an important intervention for the management of aggressive behaviour in children and adolescents. The use of CR during in-patient treatment should be based on standardized intervention strategies. The principles of such an approach include transparent agreement with all participants on fast save and staff-independent reduction of aggressive behaviour without inducing retraumatisation. In clinical practice medication that is effective both for tranquilization and prevention of aggressive escalation is recommended. Current data suggest first line treatment using neuroleptics and benzodiazepines. Due to their potential use both for rapid sedation and prevention atypical neuroleptics are of particular importance. Further controlled studies are needed to evaluate pharmacological treatment of aggressive states with potential (self) harming behaviour in children and adolescents.