 8% to 12% of youth are prescribed psychotropic medications, with those in foster care, juvenile justice systems, residential treatment facilities, and with developmental or intellectual disabilities being more likely to receive high-risk regimens. The use of these medications is often off-label and can be associated with significant risk, warranting critical evaluation of their role. Landmark trials, pediatric-specific guidelines, and state-driven initiatives play critical roles in supporting evidence-based use of psychotropic medications in children. However, there is a lack of literature describing the long-term use of these medications in youth, particularly with regard to neurobiological, physical, and social changes that occur throughout development. Deprescribing is an important practice in child and adolescent psychiatry to address concerns for overprescribing, inappropriate polytherapy, and the importance of reevaluating the role of psychotropic medications as children develop.