American pediatricians are now bearing the brunt of massive increases in demand for treatment of mental illness in children and adolescents, areas in which many pediatricians have not been well trained. It would be logical to encourage policy measures to increase pediatricians' expertise in this area to improve access to care. But the expanses in demand for services are about much more than increased incidence of biologically-based illnesses. Instead, pediatricians are caught juggling between their traditional focus on health and prevention and a rapid rise in broad socially, culturally, and economically mediated distress among young people and their families. This article explores the historical context of pediatricians' engagement with mental health and the hazards of the push toward treatment for mental illness. The historical perspective can help us develop policy more directed to broader goals of improving the mental health of our nation's children and adolescents.