Whereas physicians have become increasingly sensitive to controlling pain in children, the awareness of pain in children with severe cognitive impairments is often limited. During the course of a year, Breau and colleagues periodically surveyed caregivers of 94 children with severe cognitive impairments. More than three quarters of the children reportedly experienced pain at least once a month, most commonly due to accidental trauma. In any 1 week, one third to one half of the children experienced pain, and those with the fewest abilities experienced the most pain. As the survival rates of these children increase, the need for improved quality of care is compelling.