OBJECTIVES A recent guideline issued by the American Academy of Pediatricians (AAP) recommends to use the wait and watch approach for the treatment of acute otitis media (AOM). The objective of this study was to assess the relation between physicians' awareness, attitude and behavior to use the wait and watch approach for the treatment of AOM. METHODS A cross-sectional survey based study was conducted. The sample for the study included physicians in the Houston area. A list of pediatricians and family practitioners was obtained from the Yellow Pages. Physicians were approached on a one-to-one basis and were requested to participate in the study. A previously validated survey instrument that measured awareness, attitude and behavior towards the wait and watch approach was used. Data were coded and analyzed using SAS 9.1® to perform descriptive statistics and stepwise multivariate linear regression. RESULTS A total of 89 completed surveys were collected with a response rate of 22.25%. Majority of the respondents were pediatricians (75%), while 19.32% were family practitioners. About 44% of the physicians were aware and familiar with the wait and watch approach recommendation from the AAP guideline. In general, physicians had a positive attitude towards the wait and watch approach (3.99 ± 0.78). Physicians in this sample reported that they sometimes used the wait and watch approach in patients ≥ 2 years (2.83 ± 0.86). Awareness (β=0.256) and attitude (β=0.32) were found to be significantly associated with behavior (p<0.05) when controlled for demographic and decision-making factors in the multivariate regression model. CONCLUSIONS Awareness regarding the wait and watch approach leads to positive attitude that ultimately leads to behavior to use the wait and watch approach. Increased use of this approach may reduce antibiotic costs and resistance issues substantially. Further research on a national sample is needed to validate the study results.