OBJECTIVE: To investigate prescription patterns of insomnia medications among Chinese children, assess the current status of drug treatment, and offer data to support the guidance of clinical prescribing practices. METHODS: This study analyzed pediatric prescriptions for insomnia medications from the China Hospital Prescription Analysis Cooperation Project database across nine cities between 2016 and 2023. The analysis focused on demographic characteristics, prescription trends, and frequency of medication use among pediatric insomnia patients. Patterns of combination therapy were also examined. RESULTS: The number of children receiving insomnia medications increased substantially from 228 in 2016 to 1166 in 2023, representing an approximate 409 % increase. A growing proportion of patients were aged 12-14 years, with female patients outnumbering males by a ratio of 1.50: 1. There was an increased representation of patients from psychiatry and neurology departments. Regarding medication choices, benzodiazepines (BZDs) remained the most commonly prescribed class, though their use showed a declining trend. Similarly, non-benzodiazepine receptor agonists (nBZRAs) demonstrated a downward trend (P >
0.05), while antidepressant prescriptions significantly increased (P <
0.05). The most commonly prescribed medications within each class were alprazolam, zolpidem, trazodone, sertraline, and quetiapine. A significant proportion of patients (37.25 %) received combination therapy, with benzodiazepine receptor agonists (BZRAs) plus antidepressants being the most common combination. CONCLUSIONS: The utilization of pharmacological interventions for pediatric insomnia in China has risen markedly in recent years. Despite growing concerns about adverse effects, BZDs continue to be the primary therapeutic choice. The increasing prevalence of combination therapy suggests a trend toward more individualized treatment approaches. These findings underscore the importance of careful monitoring and rational prescribing practices in pediatric insomnia management.