The film opens to the main character Laura in the orphanage of her childhood. Shes has returned after many years in hopes of reopening. Laura, and her husband Carlos have an adapted son, Simon who is HIV positive. He is unaware of either facts. Simon has a friend named Thomas that is a ghost. His parents chalk it up to Simon just being lonely.
An elderly lady by the name of Benigna Escobeda shows up claiming that she is a social worker there to check in on Simon. Laura tells her to leave, which she does, but she is later seen sneaking around the yard near the coal shed.
During a party Laura and Simon have a fight that leads to Simon hiding from Laura. While searching she is trapped in the bathroom by Thomas. When she escapes she finds that Simon is missing. Laura believes that Benigna has taken him.
Six months, Laura sees Benigna out shopping. Benigna is hit by a bus and dies almost immediately. Laura finds a doll of the ghost boy, Thomas on the scene of the accident. The police search her home and find evdents that she worked at the orphanage and had a son named Thomas. Thomas was disfigured and so he hide his face under a shack. The children of the orphanage played a trick on him that resulted in his accidentally death.
Distressed, Laura seeks the help of a medium named Aurora. Aurora's clues lead Laura to discovering the remains of the orphanage children Laura grew up with. Benigna murdered them for revenge of her son's death.
(I can't really explain the ending in full detail so here's the one from wikipedia)
Unable to cope with the situation, Carlos leaves the orphanage as Laura promises him she will be done in two days. Laura recreates the original orphanage layout and attempts to contact the ghost children. She soon begins to see them around her when she initiates a game of "Uno, Dos, Tres, Toca la Pared" [One, Two, Three, Knock on the Wall; similar to Red Light, Green Light in America], which she used to play while growing up at the orphanage. The ghosts lead her to a hidden door within a cupboard under the stairs (La Casita de Tomas; Tomás' "little house" which Simón referred to just before his disappearance). This door leads to a hidden basement room. In the room, she sees (in her head) Simón alive and hugs him in a blanket.
As the ghost children vanish, Laura finds that the blanket is empty and the body of the deceased Simón, wearing Tomás' mask, lies behind her. She realizes that she had inadvertently caused Simón's death (she had accidentally blocked the hidden door to the basement where he was playing, trapping him inside), and that the unexplained noises she had heard were Simón trying to get out. At one point Laura had heard a loud crash which had been Simon falling through the stair railing, and onto the ground below, breaking his neck. Laura carries Simón's body upstairs and swallows many handfuls of Trankimazin capsules, begging to be with Simón again. Laura's wish is granted as the ghosts of the dead children appear and Simón returns to life in Laura's arms. Simón then tells Laura that his wish was for her to stay and take care of all the orphans.
Later, Carlos walks alone over to the memorial for Laura, Simón, and the orphans which stand outside the orphanage. Carlos returns to the orphans' old bedroom and finds on the floor a medallion of St. Anthony, the seeker of lost articles, that he had given to Laura some time earlier. He hears the sound of the bedroom door opening; as he looks up he slowly smiles.
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