Background: The use of psychotropic medication among children and adolescents has increased, but long-term studies on inpatients are scarce.

Methods: In Finland, nationwide inpatient data among children and adolescents (<18 years) were collected on one day from three different years, 2000, 2011, and 2018. Medication use was analyzed according to medication groups, individual medications, and the number of medications. Additional information included diagnoses and severity measures of suicidality, violence, and functional impairment. Logistic regression was used to analyze the changes between 2000 and 2018 and between 2011 and 2018.

Results: The most robust increase was observed in attention-deficit/hyperactivity disorder medications (between 2000 and 2018 odds ratio [OR]: 21.74, 95% confidence interval [CI]: 7.75–58.82 and between 2011 and 2018 OR: 2.20, 95% CI: 1.37–3.52), followed by antipsychotics (OR: 3.15, 95% CI: 2.34–4.24 and OR: 1.35, 95% CI: 1.02–1.81, respectively), and antidepressants (between 2000 and 2018 OR: 1.87, 95% CI: 1.36– 2.57). The use of benzodiazepines decreased notably between 2011 and 2018 (OR: 0.09, 95% CI: 0.03–0.22). When diagnoses and severity measures were included in the multivariate analysis, the increases were associated with respective diagnoses, being adolescent, and the severity of the condition.

Conclusions: Medication use increased vastly between 2000 and 2018, but levelled off between 2011 and 2018. Explanations include changes in clinical practices, the surface of new medications, increased awareness of neuropsychiatric disorders, and the replacement of benzodiazepines. More information on the long-term effects of increased use of antipsychotics and multi-medication is warranted.