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Only 20% of children with mental health issues are identified and receiving appropriate treatment nationally. The emergency department (ED) may represent a significant opportunity to provide selective pediatric mental health screening to an at-risk population.To describe the current standard of care and perceived limitations among pediatric emergency medicine (PEM) physicians regarding mental health screening.A 23-question survey on screening practices for pediatric mental illness (PMI) was sent to PEM physician participants identified through the American Academy of Pediatrics Section on Emergency Medicine mailing list.Of the 576 physicians meeting our inclusion criteria, 384 (67%) surveys were returned. Eighty-six percent of respondents indicated screening for PMI in 10% or less of their eligible patients. Overall, 43% of respondents indicated screening only if the chief complaint was psychiatric in nature. The remaining 217 physicians most commonly screened for depression (83%), suicidality (76%), and substance abuse (67%). Only 9% of physicians stated that they used evidence-based medicine in determining their screening practices. Women physicians (odds ratio, 1.94; 95% confident interval, 1.08-3.47) and those using evidence-based medicine (odds ratio, 3.88; 95% confidence interval, 1.92-7.85) were more likely to conduct screening. Significant limitations to screening identified by respondents include the following: time limitations (93%), absence of a validated screening tool (62%), limited resources (46%), and lack of training (44%). Eighty-eight percent of physicians believe that a validated and standardized screening tool would improve their ability to identify PMI.Routine PMI screening is conducted infrequently by most PEM physicians. Improved physician education/training and the development of a validated ED-specific mental health screening tool would assist PEM physicians in the early detection of PMI.