OBJECTIVES: This study examined trends in physician-prescribing of medications for children with sleep difficulties in outpatient settings in the Unites States. Additionally, this study also explored the incidence of physician-prescribing patterns of high abuse-potential medications for children, and compared prescribing trends in children versus adults. METHODS: This cross-sectional study used data from the National Ambulatory Medical Care Survey (NAMCS) from 1993–2003. Patient aged <18 years were included in the study sample. We compared this sample to the sample of patients aged 18 years and older. Office visits were considered related to sleep difficulties if relevant ICD-9 codes were recorded and if sleep difficulties was reported as the reason for the visit. Medications were retrieved using the NAMCS drug codes, and all analyses were weighted to make national estimates. RESULTS: From 1993 to 2003, approximately one million visits were made for sleep-related difficulty in children. Nearly two-thirds (63%) of these visits were related to male children and 26% of these visits were by children aged less than three years. Family practice and internal medicine physicians accounted for 21% of the patient visits. Only 2% of visits in children resulted in a prescription for a medication compared to over half the adult population. Similar trends were observed with the prescription of high-abuse potential medications, where adults were 35 times more likely to receive prescriptions of medications with very high abuse potential. There were no time-related differences observed in these prescribing patterns. CONCLUSION: The findings of this study seem to suggest that a great deal of caution is being exercised by physicians while prescribing medications for sleep difficulties in children in US outpatient settings, since most of the visits do not result in medication prescription, unlike trends observed in adult patients with similar diagnoses in the same treatment setting.