PURPOSE: Management of the pain experienced by children with cancer is critical to minimize the psychological distress and physiologic responses to their illness and its treatment. OVERVIEW: A team approach to providing care, using guidelines for pharmacologic management intertwined with non pharmacologic strategies, while individualizing the care of a specific child, is required. Pain management must start with assessment using tools that are age appropriate and well Suited to the clinical situation. Dosages of the recommended opioid and nonopioid medications that are suitable for children as well as the role of locally, systemically, and epidurally administered anesthetic agents are described by the authors. CLINICAL. IMPLICATIONS: By Mowing this practical approach, children can be prepared and supported during the various intensive oncology therapies often associated with pain that are now offered in the hope of improving the survival of children with cancer.