The study sought to measure provider recognition of family alcohol-related problems among hospitalized children and to identify characteristics distinguishing "positive" families. The study sample (N = 147) was drawn from admissions to the general pediatric medical service of a metropolitan teaching hospital. Positivity was assessed through parent and patient interviews that included standard alcohol abuse screening instruments. Provider recognition was assessed through record review and physician interview. Of the 22 families screened positive, only one was so identified by the child's attending or resident physician. Positive and "negative" families were similar in most respects, although parents in positive families were more likely to report stress and sleeping problems and adolescents were more likely to report being troubled by a parent's drinking. The similarity of positive and negative families and the low pediatrician recognition rate suggest that alcohol problems are likely to go unnoticed without a conscious screening effort.