New-onset psychosis in children and adolescents represents an uncommon and complex presenting complaint. Psychosis has been defined as a "disruption in thinking, accompanied by delusions or hallucinations" [ 1 ]. Delusions represent false, fixed beliefs that cannot be resolved through logical argument, while hallucinations are false perceptions that have no basis in external stimuli [ 1 ]. In contrast, delirium is marked by an altered sensorium with waxing and waning deficits in attention and concentration. Orientation and concentration are preserved with functional psychosis. However, the distinction between delirium and psychosis in pediatric patients can be difficult to establish, particularly in younger children. Despite these differences, hallucinations may actually represent a symptom of delirium, and separating psychosis and delirium acutely may be impossible.