Objective: To examine the social barriers that lead to less than optim
al management of pain in children. Design: Recognizing the vulnerabili
ties of infants and children and their dependence on caring adults, a
model of pain communication is proposed. The model examines (a) the pa
in experiences of children, including social determinants; (b) develop
mental variations in the capacity to encode the severity and qualities
of pain as expressive behavior; (c) adult skills and deficiencies in
decoding pain; and (d) the actions of adults predicated on the meaning
and significance attached to children's actions, Limitations in care
were examined. Data sources: The current research and professional lit
erature were accessed through searches of the Psyclit and Medline data
bases for relevant investigations on the basis of our working knowledg
e of the literature. Conclusion: Numerous deterrents to optimal care a
re identified in the domains of commonplace beliefs about the nature o
f pain in infants and children: failure to recognize the impact of soc
ialization in familial and cultural modes of experience and expression
; needs for age-specific assessment instruments: the limited capacity
to use available evidence concerning pain; the need to employ clinicia
ns, parents, and other adults more effectively in delivering care; and
structural problems in the health care system.