We sought to identify needs for behavioral health care in a large, urban pediatric primary care (PPC) clinic serving a population covered by Medicaid. Specifically, children (N = 197; 120 girls; 91 % African American) ages 8-17 years and their caregivers completed measures of internalizing and externalizing symptoms (RCADS, RCADS-P, MASC, and SDQ). Clinical elevations on all but one domain of the SDQ were significantly higher than expected. However, self-reported anxiety and depression symptoms were consistent with expectations. These findings suggest urban, low-income, primarily African American youth presenting at a PPC clinic demonstrate significant levels of behavioral and emotional symptoms. Implications of the findings include the need to ask both parents and children about child behavioral health problems and the possible influence of screening tool selection on detection.