The prescription of psychotropics has increased in the pediatric population all over the world since about 15 years. This increase is widely varying depending on the country and molecules, ranging from 1.5- to 5-times in many European countries and the United States [
1,
2]. In France the frequency of annual psychotropic prescriptions in children and adolescents is about 2.2% [
2]. The increase in antipsychotic (AP) use is explained by a dramatic increase in atypical or second-generation AP (SGA) use, while typical or first-generation AP (FGA) prescriptions decreased [
3]. SGA have a comparable efficiency to FGA with better neuromuscular safety [
4]. Many AP medications in the pediatric population are prescribed off-label, especially in very young children [
5,
6]. Prescriptions are therefore frequently unsupported by rigorous scientific evidence. SGA drugs are actually widely used to treat many psychiatric disorders such as schizophrenia, bipolar, autistic spectrum, attention deficit hyperactivity or behavior disorders in the pediatric population [
7‐
9]. However, the pediatric literature data show several adverse events (AE) in children and adolescents treated with AP [
10‐
14]: muscular (muscle weakness, extrapyramidal syndrome, akathisia, dystonia, dyskinesia, catatonia), metabolic (weight gain, obesity, dyslipidemia, hyperglycemia, diabetes, insulin resistance, hypertriglyceridemia, hypercholesterolemia) and endocrine AE (hyperprolactinemia, vitamin D deficiency). Children treated with SGA are more likely than adults to experience AE. Woods et al. [
15] studied more than 4 million prescriptions of olanzapine. They observed that the relative risk of sedation, weight gain, dystonia and tardive dyskinesia is 2 to 5 times greater in children or adolescents than in adults. Additionally, only few prospective studies examine antipsychotic adverse events in naive pediatric populations [
16‐
18]. Several European and American authors are worried about long-term effects of antipsychotic medication on children’s health and recommend more safety guidelines and management of adverse events [
19‐
26]. In fact, there are currently few guidelines for the management of adverse events in youth treated by antipsychotics [
27‐
29]. On the European level, the lack of official guidelines for standardized follow-ups in the pediatric population is surprising given the probably higher relative risk of AE in this population. Furthermore, the incidence of AE in a drug-naive population is less well documented, as the typical study populations consist of pediatric patients who have already been exposed to an antipsychotic drug [
30,
31]. In France, since 2007 only two second-generation antipsychotics have been granted market authorization: risperidone for severe behavioral disorders from 5 years of age; and aripiprazole for schizophrenia from the age of 15 years and recently for maniac episodes associated with bipolar I disorder from the age of 13. The frequency of antipsychotic off-label prescriptions is as high as 69% in French university pediatric hospitals [
32]. In March 2010, the French National Agency for Medicines and Health Products Safety (Agence nationale de sécurité du médicament et des produits de santé, ANSM) recommended cardiometabolic monitoring for all adult subjects treated with psychotropic drugs. There is no official recommendation for the safety monitoring in the pediatric population. This is paradoxical, since this population is at high risk of adverse events. In addition, adverse events during AP use in children are often poorly and insufficiently monitored in France in general practice.