This study examined whether physical pain, mental health symptoms, and provider characteristics were associated with the discussion of children’s behavior, mood, getting along with others, school performance, family stress, and parent stress during 800 pediatric primary care visits to 54 providers in 13 clinics. The discussion of psychosocial health was more common when the child demonstrated hyperactivity symptoms, the visit was for a mental health problem, and the provider was a woman or reported greater confidence in mental health treatment skills, but less common when the child demonstrated physical pain. Provider gender, psychosocial orientation, the reason for the visit, and the child’s characteristics did not explain the inverse relationship between pain and discussion. This suggests that multilevel factors that describe the child and provider are associated with the discussion of psychosocial health, and that pain interferes with discussion during all types of visits and during visits with children who are impaired by mental health symptoms.