Introduction

It is now well accepted by neuroscientists and pain specialists that the nervous system is sufficiently developed to process nociception before birth, and consequently, children must be assumed to experience pain from birth onward.¹ Indeed, due to a more robust inflammatory response and the lack of a central inhibitory influence, infants and young children actually may experience a greater neural response, i.e., more pain sensation and pain-related distress, following a noxious stimulus than do adults. The impact of painful experience on the young nervous system is so significant that long-term effects can occur, including a lowered pain tolerance for months after a pain-producing event.²

Given the certainty that neonates and preverbal children experience pain, the long history of undertreatment^3,4 cannot be justified by the lack of easy communication with these patients, and certainly not with older children and adolescents. The multifactorial sources of undertreatment of pediatric pain should be understood and provide the basis for professional and parental education, and system changes, that are necessary to yield best practices in pediatric pain control.