Objective: Obstructive sleep-disordered breathing (SDB) is the most common indication for tonsillectomy and differences in pediatric tonsillectomy rates among sociodemographic groups have been well documented. However, variations in screening for SDB in the primary care setting have not been well delineated and we aim to study this upstream source in tonsillectomy access. Study Design: Retrospective chart review Setting: Tertiary hospital network Methods: Demographics and SDB screening status were extracted from well-child visits for children ages 2-12 years. Multivariable logistic regression was used to identify factors associated with screening for SDB. Results: Of 1,001 charts reviewed, a total of 809 children met inclusion criteria (median age 5 IQR [3-8] years, 50.3% female, 49.7% male). Only 45.4% children were screened for SDB, of whom 59 (16.7%) had SDB. Multivariable logistic regression revealed that when controlling for age, sex, race, ethnicity and comorbidity, the odds of being screened for SDB were lower for Black children than their White counterparts (OR 0.59, 95%CI [0.42-0.84], p=0.003). However, when controlling for the involvement of a trainee and use of a template, racial differences between White and Black children were no longer significant (OR 0.98, [0.66-1.48], p=0.53). However, racial differences persisted for children of other race (OR 0.48, [0.26-0.88], p=0.009). The odds of being screened for SDB was higher with use of templated note (OR 3.71 [1.85-7.44]; p< 0.001) but lower if a medical trainee was involved (OR 0.06, [0.03-0.11], p<0.001) Conclusions: Less than half of children presenting for well-visits were screened for SDB symptoms in this cohort. Some racial differences in screening were mediated by trainee involvement or note template use, which may be avenues to improve equitable access to workup and treatment.