Benzodiazepines are generally only appropriate for use before procedures. Lorazepam probably has less risk of misuse than others. Lorazepam is also the first-line, but off-label, treatment for catatonia.

Due to the lack of large randomized controlled data to support its use and the potential for side effects, clonazepam should be avoided. If you decide to use it, keep it very short term and deploy it adjunctively in kids who exhibit only partial response to first-line therapies (SSRI, SNRI) or have severe anxiety.

Despite the lack of large randomized controlled data to support first-line use, buspirone may be used adjunctively in kids who exhibit partial response to first-line therapies for anxiety (SSRI, SNRI), without the sedation and abuse potential burden of benzodiazepines.

Anxiety is perhaps the most frequent symptom for which child psychiatrists are consulted.

Over the course of a career, most of us realize that pediatric psychopharmacology is more art than science, and that much of the knowledge we’ve acquired over the years has come from our work with patients after completing residency and fellowship. Here are some hard-won tips and pearls that you might find useful in your practice.