Since the identification of fetal alcohol syndrome (FAS) in 1973, significant inroads have been made towards understanding the effects of alcohol on fetal development. However, it is not clear if these findings are considered clinically relevant by pediatricians. This survey was designed to assess clinical knowledge, practice, and attitudes concerning alcohol-related birth defects. Data were collected in a questionnaire that was mailed to 234 randomly selected Massachusetts pediatricians. Responses suggest that a substantial proportion of pediatricians have knowledge about the effects of alcohol on pregnancy. However, many considered themselves unprepared to deal with this topic. More physicians suspected FAS/FAE than made the diagnosis. Almost three fourths reported they would find professional education in this area helpful. Broader dissemination of research findings in clinically relevant formats and improving the sense of preparedness among pediatricians have the potential to improve the care of children born to heavily drinking pregnant women.