diff --git a/content/en/docs/languages/js/getting-started/nodejs.md b/content/en/docs/languages/js/getting-started/nodejs.md
index 4197b9118e0f..ebdd1a8787a1 100644
--- a/content/en/docs/languages/js/getting-started/nodejs.md
+++ b/content/en/docs/languages/js/getting-started/nodejs.md
@@ -24,6 +24,10 @@ Ensure that you have the following installed locally:
 - [TypeScript](https://www.typescriptlang.org/download), if you will be using
   TypeScript.
 
+{{% alert title="Note" color="info" %}}
+Much of OpenTelemetry JS documentation is written assuming the compiled application is run as CommonJS.
+{{% /alert %}}
+
 ## Example Application
 
 The following example uses a basic [Express](https://expressjs.com/)
@@ -247,6 +251,17 @@ Listening for requests on http://localhost:8080
 
 {{% /tab %}} {{< /tabpane >}}
 
+### Instrumentation for ECMAScript Modules
+
+If your application is written in JavaScript as ESM, or compiled to ESM from TypeScript, then a loader hook is required to properly patch instrumentation.
+The custom hook for ESM instrumentation is `--experimental-loader=@opentelemetry/instrumentation/hook.mjs`.
+This flag must be passed to the `node` binary, which is often done as a startup command and/or in the `NODE_OPTIONS` environment variable.
+
+```console
+$ node --experimental-loader=@opentelemetry/instrumentation/hook.mjs --require ./instrumentation.js app.js
+Listening for requests on http://localhost:8080
+```
+
 Open <http://localhost:8080/rolldice> in your web browser and reload the page a
 few times. After a while you should see the spans printed in the console by the
 `ConsoleSpanExporter`.
diff --git a/content/en/docs/languages/js/instrumentation.md b/content/en/docs/languages/js/instrumentation.md
index 3cd001056f1d..de461da14c4f 100644
--- a/content/en/docs/languages/js/instrumentation.md
+++ b/content/en/docs/languages/js/instrumentation.md
@@ -33,6 +33,10 @@ about manual instrumentation.
 You don't have to use the example app: if you want to instrument your own app or
 library, follow the instructions here to adapt the process to your own code.
 
+{{% alert title="Note" color="info" %}}
+Much of OpenTelemetry JS documentation is written assuming the compiled application is run as CommonJS.
+{{% /alert %}}
+
 ### Dependencies {#example-app-dependencies}
 
 Create an empty NPM `package.json` file in a new directory:
diff --git a/content/en/docs/languages/js/libraries.md b/content/en/docs/languages/js/libraries.md
index 874c186e8525..8dd08598fd77 100644
--- a/content/en/docs/languages/js/libraries.md
+++ b/content/en/docs/languages/js/libraries.md
@@ -19,6 +19,11 @@ For example,
 will automatically create [spans](/docs/concepts/signals/traces/#spans) based on
 the inbound HTTP requests.
 
+{{% alert title="Note" color="info" %}}
+Much of OpenTelemetry JS documentation is written assuming the compiled application is run as CommonJS.
+If the application runs as ESM, add the loader hook as specified in [Getting Started](/docs/languages/js/getting-started/nodejs/#instrumentation-for-ecmascript-modules).
+{{% /alert %}}
+
 ### Setup
 
 Each instrumentation library is an NPM package. For example, here’s how you can
diff --git a/content/en/docs/languages/js/propagation.md b/content/en/docs/languages/js/propagation.md
index 98223415eecf..deaef6eb1dbe 100644
--- a/content/en/docs/languages/js/propagation.md
+++ b/content/en/docs/languages/js/propagation.md
@@ -7,6 +7,10 @@ cSpell:ignore: rolldice
 
 {{% docs/languages/propagation js %}}
 
+{{% alert title="Note" color="info" %}}
+Much of OpenTelemetry JS documentation is written assuming the compiled application is run as CommonJS.
+{{% /alert %}}
+
 ## Automatic context propagation
 
 [Instrumentation libraries](../libraries/) like
diff --git a/content/en/docs/languages/js/resources.md b/content/en/docs/languages/js/resources.md
index f0dc34e02c6e..bc57325cd604 100644
--- a/content/en/docs/languages/js/resources.md
+++ b/content/en/docs/languages/js/resources.md
@@ -15,6 +15,10 @@ Node.js SDK.
 Follow the instructions in the [Getting Started - Node.js][], so that you have the
 files `package.json`, `app.js` and `tracing.js`.
 
+{{% alert title="Note" color="info" %}}
+Much of OpenTelemetry JS documentation is written assuming the compiled application is run as CommonJS.
+{{% /alert %}}
+
 ## Process & Environment Resource Detection
 
 Out of the box, the Node.js SDK detects [process and process
diff --git a/content/en/docs/languages/js/serverless.md b/content/en/docs/languages/js/serverless.md
index c418b95e00c3..222af217db43 100644
--- a/content/en/docs/languages/js/serverless.md
+++ b/content/en/docs/languages/js/serverless.md
@@ -8,6 +8,10 @@ cSpell:ignore: otelwrapper
 This guide shows how to get started with tracing serverless functions using
 OpenTelemetry instrumentation libraries.
 
+{{% alert title="Note" color="info" %}}
+Much of OpenTelemetry JS documentation is written assuming the compiled application is run as CommonJS.
+{{% /alert %}}
+
 ## AWS Lambda
 
 {{% alert title="Note" color="info" %}}