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Objective. To provide a self-described assessment ofpediatricians' and family physicians' management of childhood depression. Design. Mail survey of 595 general pediatricians and 557 family physicians in North Carolina. Results. The response rate was 66%. Most primary care physicians used referral (65%) and counseling (61%) for management of childhood depression. Family physicians used medications more commonly (18% vs 9%), and pediatricians referred patients more commonly (77% vs 48%). In logistic regression analysis, physicians comfortable with management of depression (odds ratio [OR], 4.8: 2.7-8.4), physicians who believed that antidepressants are more effective than counseling (OR, 2.6: 1.4-4.8), and family physicians (OR, 2.2: 1.9-4.1) were more likely to have used medications for childhood depression. Conclusions. Most primary care physicians refer pediatric patients with depression; however, practice patterns vary by specialty and other factors. Future studies must consider the role of primary care and evaluate how interspecialty variations affect costs and outcomes of childhood depression.