Whether to prescribe psychotropic medication for children with anxiety and sleep disorders is an ethical issue that many primary care providers will face.

Although benzodiazepines, for example, are frequently used for the treatment of these disorders in children and have been shown to be effective, they have also been associated with a high level of abuse, adverse side effects, and potential for addiction.

Therefore, it is ultimately up to each clinician to determine if it is appropriate to initiate this type of medication in a child (Schatzberg, Cole, DeBattista, Manual of Clinical Psychopharmacology, 2010). As always, the benefits must be weighed against the risks.

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Prescribers and clinicians should first attempt to implement nonpharmacologic interventions if the child has mild anxiety symptoms or simply requires education and sleep hygiene. Cognitive behavioral therapy can be used as a first-line intervention in children with generalized anxiety disorders, versus immediately initiating a medication (Hirshfeld-Becker et al. J Consult Clin Psychol. 2010;78[4]:498-510).

On the other hand, there are instances in which the severity or chronicity of an anxiety disorder or sleep disorder may warrant pharmacotherapy. Therefore, a practitioner may be faced with the dilemma of whether to initiate a medication in a young child, given that few trials have been conducted in this particular population.

Although few psychotropic medications are approved for use in children, some antidepressants are used off-label in children for the treatment of various mental disorders. Selective serotonin reuptake inhibitors are considered to be effective for the treatment of certain anxiety disorders and can be an option for clinicians after performing a comprehensive assessment of the patient (Emslie et al. J Am Acad Child Adolesc Psychiatry. 2002;41[10]:1205-1215).