Two hundred and eight medical records subdivided into two age groups, < 2 years (n = 49), and two to 17 years (n = 159) were used to assess providers' practice of documentation and intervention for overweight and associated risk variables, among children from a multi-ethnic inner-city population. The Body Mass Index (BMI) and/or weight to height ratio > or = 90th percentile for age and sex were used to define overweight, or at risk for overweight. Documentation for excessive weight and intervention, resident-physician training level, demographics, blood pressure, and cholesterol values were recorded. Overweight was identified in 36% of the pediatric patients. Twenty-nine percent of the affected children were documented, and all but two had an intervention. Exercise, nutritional and/or behavioral counseling were prescribed with nutritional counseling being the most frequent. Blood pressure and cholesterol levels were measured more frequently in overweight children than in normal weight children. Children < two years of age with BMI or weight/height ratios > or = 90th percentile had no documentation or intervention for suspected overweight. We conclude that childhood overweight was highly prevalent, and under-recognized as determined by medical record documentation. Further study is needed to determine effective provider education programs for preventing, detecting and managing overweight during childhood.