The earlier the onset of schizophrenia, the more severe the disease. Atypical antipsychotics are the first-line treatment of choice in children as in adults. Nonetheless, most of these drugs have not been approved for use in patients younger than 15 years. In children and adolescents, the atypical antipsychotics have fewer adverse effects than first-generation antipsychotics do, but are nonetheless not tolerated as well as in adults. Among the notable adverse effects are weight gain, sedation, and hyperprolactinemia. The most recent data suggest the need for prevention and attentive monitoring of the components of the metabolic syndrome (elevation of blood pressure, waist circumference, HDL cholesterol, blood glucose, and triglycerides).