In every pediatric head and neck surgery, there are key moments that define short-and long-term outcomes, potential complications, and challenge us to make the best intraoperative decisions.   Recognizing these crucial moments and developing strategies to optimize our judgement in each case requires awareness, experience, and humility.  In this panel, four pediatric otolaryngologists with high volume, focused practices in pediatric head and neck surgery will discuss these "critical ten seconds" across a broad range of common pediatric head and neck surgeries. When does the margin really matter? How might specific treatment aims influence a decision to deviate from the “usual” surgical approach? When is it time to sacrifice a key nerve or make a cosmetically undesirable incision? When is it time to be our own worst critics and reassess our scope, pass on a surgery, or phone a colleague for assistance? What mental heuristics will bring us through the hardest times? We will share experiences from both our most overtly challenging head and neck tumor cases as well as those that were surprisingly and unexpectedly difficult. We will incorporate decision making science into our discussion, including concepts of cognitive bias and decision fatigue. Anticipatory strategies that allow for early identification of surgical inflection points will be presented. Participants should leave the session with strategies to cope with difficult intraoperative decisions in common pediatric head and neck surgeries, so that we can all bring our best to those critical ten seconds for every child. We will also consider the postoperative phase, particularly after near-misses or difficult decision-making scenarios, and how structured debriefing with colleagues provides opportunities for reflection and improvement.