Clozapine remains the gold-standard medication for treatment-resistant schizophrenia, yet its use in young people is limited despite emerging evidence supporting efficacy. In this journal, Walker et al highlight the unmet need for training and education on clozapine prescribing in child and adolescent populations, reinforcing concerns raised by leading experts about real-world implementation barriers. In this commentary on their article, we consider some of these concerns, particularly regarding therapeutic benefit and metabolic and haematological safety. We conclude that, given the severe consequences of treatment delay and the prognostic burden associated with early-onset schizophrenia, a proactive, algorithmic and well-supervised approach to clozapine initiation in youth is essential.