For an R-Rated movie, The Orphanage is surprising appropriate, and could have easily been PG-13. There is no sex or nudity at all, and there are only two swears (including one F-word) although they only appear in the subtitles since the audio is in Spanish. There is even very little gore or violence-although there is one scene where we get a 5-second glance at the mutilated face of a car crash victim; in another scene, we get a quick glance at the distorted face of a child born with facial deformities. Other than that, though, there are no disturbing or gory images.
Young children may be disturbed by some elements in the plotline, though. Although there is little gore, The Orphanage is still meant to be a psychological horror film, so its overall tone is very dark and creepy. A theme of dead/dying children is present throughout, including some talk of murdered children and an instance of suicide. In the beginning of the film, a child is said to be HIV positive (nothing sexual is implied). The end of the film is very tragic but moving, young kids may find it upsetting though.
Overall, this is an extremely poignant film about a mother's undying love as she searches for her missing son. It is beautifully written and has an excellent storyline. If your kids are uncomfortable about talk of death, or if you are not comfortable with your kids hearing talk of death, this may not be the movie for you. Other than that, though, there is no real inappropriate content.
My 9-year-old sister watched this and was fine. In my opinion, this would be completely appropriate for anyone 13+; for younger kids, you should judge for yourself on a case-by-case basis. As long as your kids are not easily scared, The Orphanage is okay to watch as a family movie.