OBJECTIVES: Children and adolescents with severe behavioral health problems are often treated with complex psychoactive medication regimens with unclear diagnostic and treatment history, amplified by sporadic and often poorly-coordinated treatment. Recently, the use of antipsychotic medications in children has grown substantially among DMA enrollees and now constitutes $44.4 million in pharmacy reimbursement costs annually. METHODS: Policy was developed that required prescribers to register patients via A+KIDS, a web portal, when prescribing antipsychotics in patients under 18 years old before the medication could be approved for pharmacy reimbursement. Required registration elements included a patient’s primary  diagnosis, target symptom, initiating prescriber, caregiver support of medication use, adverse drug events, and metabolic monitoring deemed best practice. A+KIDS registry data, including children age 17 and under data, were used to examine the first two years of the registry.   RESULTS: A total of 1650 providers made 51346 requests for 20434 patients in the first two years of the registry. The most commonly requested drug was Risperidone (40.68% of the requests). “Bipolar Disorder,” "ADHD," and “Oppositional Defiant Disorder” were the three most common diagnoses (33.76%). "Aggression towards others," "Irritability" and “Tantrums/temper” were the most common target symptoms (62.12%). Over half (52.48%) of the medications were first prescribed by an outpatient psychiatrist. Glucose monitoring increased from 52% to 64% and lipid monitoring from 27% to 46% for children on antipsychotics.   CONCLUSIONS: Most prescribers of antipsychotics in children were enthusiastic about participating in the prescribing registry, expressing concern about prescribing in an ill-coordinated environment with high risk of serious adverse events and long term side effects. Asking prescribers about glucose and lipid values increased monitoring significantly with implementation of the registry. The registry has the potential for increasing awareness about the effects and usefulness of these medicines by enhancing claims data with clinical data.