Context: One of our primary goals during the resuscitation of a child is to prevent cardiopulmonary arrest. This necessitates rapid intervention for respiratory failure or shock, which often requires reliable vascular access. Evidence Acquisition: Pubmed, Google Scholar, UptoDate Results: As many pediatric healthcare providers know, placing a peripheral IV can be increasingly difficult in severely ill children, particularly during states of shock. It’s important to consider intraosseous access early in the resuscitation process ideally before the child reaches a critical state that may require CPR. In Emergency Department, the ability to secure intravenous (IV) access quickly is critical for effective patient management but as a thumb rule sicker the child, difficult is securing IV line.every emergency physician must be proficient in placing an intraosseous line, utilizing whatever equipment is available, as this skill can be lifesaving. In critical situations, such as cardiopulmonary arrest, rapid IO access allows for immediate administration of resuscitation medications, fluids, and blood products, ensuring that treatment begins without delay 2. Intraosseous access not only enhances the chances of successful resuscitation but also serves as a bridge to more secure vascular access options, should be required later in the patient’s care. Conclusion: Therefore, familiarity with IO placement techniques and timely intervention can significantly impact patient outcomes in emergency settings. Intraosseous access is indicated for children facing critical illness or injury when peripheral venous access has failed. The decision to transition to IO access depends on the child’s condition rather than a specific timeframe or number of attempts.