Alcohol use and abuse by children and adolescents continue to be major problems. Although the minimum legal drinking age is 21 years old in all 50 States, the annual Monitoring the Future Study of alcohol and drug use by American students has consistently shown that alcohol is the drug most often used and abused by children and adolescents. Factors that contribute to alcohol use and abuse by children and adolescents include genetic and family influences, adolescent development, peer influence, media influence, and community attitudes. To properly cope with this serious problem, pediatricians must have comprehensive and integrated substance abuse training, so they will be prepared to properly screen, identify, evaluate, manage, and refer patients to competent and qualified health professionals for further assessment and treatment as indicated. Pediatricians should strongly advise against the use of alcohol and illicit drugs as well as the non-therapeutic use of approved psychoactive drugs by children and adolescents. They should discuss the hazards of alcohol and other drug use with their patients as a routine part of risk-behavior assessment, with attention to a family history of alcoholism. They should use prenatal and preventive child health care visits as an ideal opportunity to explore the family history and attitudes regarding alcohol use and discuss with parents the effects of positive and negative role modeling on their children. Further, pediatricians should discuss the issue of adolescent parties with alcohol and discourage parents from allowing underage drinking at home or other locations. Pediatricians should participate in school, community, and State efforts to promote alcohol-abuse prevention programs. 45 references and a listing of questions to identify adolescent with alcohol abuse problems