Pediatricians have long been leaders for professional involvement in communities and in community child health. However, changing demographics, increased medical school debt, and demands by large group practices to generate income may conflict with desires to become involved. This study took advantage of the American Academy of Pediatrics Periodic Surveys to examine changes in reported involvement from 1989 to 2004. The proportion of pediatricians involved in community child health decreased from 56.6% in 1989 to 45.1% in 2004, and these activities were increasingly volunteer rather than paid (48.6% in 1989 to 79.6% in 2004). There was decreased involvement of pediatricians in schools, neighborhood health centers, child care centers, child protection agencies, and child advocacy organizations. More pediatricians in 2004 believed that their current level of activity was inadequate.