Emotional growth and well-being are as important for very young children as cognitive and physical development. As managed care approaches are increasingly used for health care in the public sector, the needs for identification and treatment of mental health problems can often be overlooked. However, the authors maintain that many of the goals of strong early childhood programs are very compatible with managed care approaches, if careful planning occurs. The authors also suggest various strategies and tactics that advocates for very young children can use to ensure that public managed care systems address the mental health and emotional needs of very young children.