ABSTRACT. Objectives. Identify pediatrician (faculty and resident) beliefs about spirituality and religion (SR) in medicine and the relationship of those beliefs to SR behavior and experiences in clinical practice.Methods. A self-report questionnaire was administered to full-time pediatric faculty (N ‫؍‬ 65) and residents (N ‫؍‬ 56) of an urban children's hospital affiliated with a school of medicine. The response rate was 70.8% among faculty (n ‫؍‬ 46) and 78.6% among residents (n ‫؍‬ 44). Respondents indicated the extent of their SR inquiry and the frequency of their SR experiences (requests by patients or families to discuss SR or pray), routinely and during health crisis, and rated 19 belief statements about SR in pediatrics.Results. Few pediatricians routinely ask about SR issues. Faculty were more likely than residents to ask about religious affiliation, whereas residents were more likely to be asked to pray during health crises, to believe that SR has health relevance, and to perceive pediatrician-initiated prayer as appropriate. Composite scores indicated that physicians who did not expect negative patient reactions to SR inquiry and prayer, who believed more strongly that SR is relevant to pediatric outcomes, and who felt more capable with SR inquiry were more likely to engage in SR inquiry and to experience SR requests.Conclusions. Pediatrician beliefs with respect to health relevance of SR, patient reactions to SR inquiry, and physician capabilities regarding SR in the clinic are strongly related to their clinical practice concerning SR inquiry and experiences. Correction of physician misperceptions about SR issues and incorporation of religious sensitivity into physician training may remove barriers to both patient and physician SR inquiry. Pediatrics 2003;111:e227-e235. URL: http://www.pediatrics.org/cgi/ content/full/111/3/e227; pediatrics, religion in medicine, physician's role, attitude of health personnel, internship and residency, medical education.ABBREVIATIONS. SR, "spiritual and religious" or "spirituality and religion"; SD, standard deviation.