This article explores the issue of developmental and behavioral health supervision in primary care, and suggests ways in which pediatricians can provide a greater focus on early social-emotional development during health care visits. Specifically, the author addresses some of the obstacles to addressing social and emotional development in the pediatric visit, and suggests ways in which the health care visit can be used as an opportunity to optimize early emotional health. The author explores how the parent-child attachment influences development and how the pediatric health care visit can be an opportunity to observe the quality of the caregiver's interactions with the child, and vice versa, during the stress of a visit to the doctor. The author uses an ecological perspective to highlight the dual role of the pediatric provider: to be attentive to the needs of the family in the moment of the primary care visit, and to partner with community resources to optimize early social-emotional development.