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<b>Objective:</b> To characterize current practices and awareness regarding analgesia and sedation management among healthcare providers in pediatric intensive care unit (PICU) across China, and to explore the implementation status of related strategies. <b>Methods:</b> A two phase nationwide cross sectional questionnaire study (2018 and 2022 ) was conducted, involving 53 and 52 hospitals respectively across 22 provinces, 4 municipalities, and 5 autonomous regions. The study assessed the status and awareness of analgesia and sedation management. The questionnaire comprised 3 sections: demographic data (7 items), awareness level assessment (8 items), and implementation status (18 items). The differences were analyzed using the chi-square test or Fisher's exact probability test. <b>Results:</b> A total of 265 and 528 questionnaires were collected in 2018 and 2022,respectively. Analgesia and sedation practices were universally implemented across all participating PICU. In 2022, awareness of the organ-protective effects of analgesia and sedation, as well as recognition of delirium and withdrawal syndrome, was significantly higher than in 2018 (both <i>P<</i>0.001). The Facial Pain Scale was the most commonly used pain assessment tool, with utilization rates of 86.8% (46/53) in 2018 and 80.8% (42/52) in 2022. For sedation assessment, the Ramsay Sedation Scale ranked as the most prevalent tool, used in 85.0% (45/53) and 75.0% (39/52) hospitals in 2018 and 2022, respectively. The Comfort Behavior Scale (COMFORT) was used in 10 hospitals (18.9%) in 2018 and 18 hospitals (34.6%) in 2022, while its revised version (COMFORT-B) was used in 10 hospitals in both years (18.9% in 2018 and 19.2% in 2022), indicating limited clinical adoption. The most frequently administered analgesic was fentanyl, accounting for 40.0% (106/265) in 2018 and 22.5% (119/528) in 2022. The most common sedative was midazolam, accounting for 70.9% (188/265) and 37.9% (200/528) of use in 2018 and 2022, respectively. In 2022, the application rates of remifentanil and dexmedetomidine were both higher than those in 2018 (18.0% (95/528) <i>vs.</i> 5.7% (15/265), 22.3% (118/528) <i>vs.</i> 6.8% (18/265), <i>χ</i><sup>2</sup>=22.46, 30.05, both <i>P</i><0.001). The combination of fentanyl and midazolam remained the most frequently used analgesic-sedative regimen, accounting for 45.3% (120/265) in 2018 and 22.3% (118/528) in 2022, respectively. <b>Conclusions:</b> PICU clinicans' awareness of the organ-protective effects of analgesia and sedation, as well as the identification of withdrawal syndrome and delirium, has been significantly enhanced. The clinical utilization rate of remifentanil and dexmedetomidine has also increased notably in 2022. Moving forward, further standardization of analgesia and sedation protocols is imperative to optimize the quality of sedation-analgesia care in the PICU.