Psychotropic medications are increasingly used to treat children and adolescents with mental health conditions. Between the years 1994 and 2001, there was a 191.7% increase in number of office visits resulting in a psychotropic medication prescription among children and adolescents. Many drugs are prescribed to children "off-label", whereby they are used inconsistently with their FDA-approved use. Except for stimulants used to treat attention deficit hyperactivity disorder, little efficacy data exists for the pediatric use of other psychotropic medications, including antidepressants and mood stabilizers, antipsychotics, anxiolytics, and sedatives. Often, two or more of these agents are prescribed at once (i.e., "polypharmacy"), leading to possible complications in particularly vulnerable pediatric populations. In addition, many children are prescribed medications containing black-box warning labels indicative of potentially significant health risks. The increased prevalence of school-age children prescribed psychotropic medications, coupled with the paucity of pediatric drug research, indicates the trends of off-label prescribing, polypharmacy, and the pediatric use of drugs with black-box warnings will continue. School psychologists should have awareness and knowledge of how these practices can effect the students they will inevitably work with in assessment, intervention, and counseling. This article presents a primer of off-label prescribing, polypharmacy, and black-box warnings for school psychologists. (Contains 6 resources.)