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This prospective study aimed to examine QTc changes in child psychiatric patients during the implementation of an SGA monitoring protocol. QTc was calculated using both Bazett\u2019s (QTcB) and Fridericia\u2019s (QTcF) formula and categorised as normal (\u2264\u2009450\u00a0ms), borderline (&gt;\u2009450,\u2009&lt;\u2009470\u00a0ms), prolonged (\u2265\u2009470,\u2009&lt;\u2009500\u00a0ms), or significantly prolonged (\u2265\u2009500\u00a0ms). The study patients (n\u2009=\u200955, 76% males, median age 9.9\u00a0years) were followed for a median of 9\u00a0months. In all of them SGA (risperidone, aripiprazole, quetiapine) treatment was off-label. The median olanzapine equivalent dose was 2.0\u00a0mg. Concurrent ADHD medication was used by 40%. A baseline (BL) ECG was available for 78%. A BL and at least one follow-up ECG existed for 75%. The mean change in QTcB was 18.1\u00a0ms (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009\n                    <jats:italic>0.001<\/jats:italic>\n                    ) and in QTcF 17.2\u00a0ms (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u2009\n                    <jats:italic>0.001<\/jats:italic>\n                    ). The QTcB change was significantly greater in females (31.7\u00a0ms vs 13.2\u00a0ms,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u2009\n                    <jats:italic>0.046<\/jats:italic>\n                    ). During the follow-up, 11% had borderline (n\u2009=\u20095) or significant (n\u2009=\u20091) QTcB prolongation. In 5\/6, the prolongation appeared after a change in psychotropic medication. No arrhythmias were detected.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    :\u00a0Low\u00a0to moderate-dose SGA treatment in children seems to be safe in the light of cardiac adverse effects. However, individual risk assessments and systematic ECG monitoring are necessary. Particular attention should be paid to medication changes and female patients.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td align=\"left\" colspan=\"2\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\u00a0\n                              <jats:italic>Second-generation antipsychotics (SGAs) may prolong the rate-corrected QT interval (QTc) and increase the risk for ventricular arrhythmias.<\/jats:italic>\n                              \u2022\u00a0\n                              <jats:italic>The risk seems to be low in healthy children, but data on long-term treatment and patients with risk factors are scarce.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td align=\"left\" colspan=\"2\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\u00a0\n                              <jats:italic>In this clinical sample of 55 children using SGAs, QTc prolongation was seen after changes in psychotropic medication.<\/jats:italic>\n                              \u2022\u00a0\n                              <jats:italic>Individual cardiac risk assessment including family history and monitoring of SGA treatments is vital. Attention should be paid to medication changes and female patients.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-025-06447-4","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T06:28:20Z","timestamp":1757572100000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low to moderate-dose off-label use of second-generation antipsychotics seems to be safe in the light of cardiac adverse effects in child psychiatric patients"],"prefix":"10.1007","volume":"184","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4772-3858","authenticated-orcid":false,"given":"Kirsi","family":"Kakko","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raili","family":"Salmelin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaija","family":"Puura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tuija","family":"Poutanen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"issue":"9","key":"6447_CR1","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1089\/cap.2018.0037","volume":"28","author":"ES Lee","year":"2018","unstructured":"Lee ES, Vidal C, Findling RL (2018) A focused review on the treatment of pediatric patients with atypical antipsychotics. 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Approval was granted by the Ethics Committee of the Pirkanmaa Hospital District, Tampere, Finland (February 10\n                      th\n                      , 2015 \/ reference number R15012).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics declaration"}},{"value":"Informed written consent was obtained from all patients aged 7\u00a0years or older and from all parents or legal guardians involved in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"609"}}