Antipsychotic (neuroleptic) drugs are used in the treatment of various psychiatric disorders in children and adolescents. There is a lack of information about the efficacy and safety of antipsychotics in young people. Much of the information available is extrapolated from adult studies; in particular, little is known about the long-term effects of these drugs on the development of the central nervous system. Over the last two decades, typical antipsychotics have largely been replaced by atypical antipsychotics. With this increase in use of atypical antipsychotic drugs, there has been growing concern about the appropriate use of these drugs and the fact that they appear to be associated with metabolic abnormalities such as weight gain, diabetes and related cardiovascular effects. This paper provides a review of current practice and evidence based use of antipsychotic drugs in children.