Aim: To compare the severity of paediatric pain as assessed by the triage nurse, child and parent. Methods: This was an analytical, observational study undertaken in a tertiary referral emergency department between January and June (inclusive) 2006. A convenience sample of children (aged 3-15 years) with painful conditions was enrolled. The triage nurse, child and parent were asked to assess the child s pain using the Wong-Baker FACES pain rating scale (young children) or a linear numerical pain rating scale (nurse, older children, parent). Each participant was blinded to the assessments of the others. Results: Eighty-six patients were enrolled: 52 (60.5 ) male, mean age 9.1 (standard deviation 4.0) years. The median (inter-quartile range) pain scores recorded by the nurses, parents and children were 4.0 (3.0-6.0), 6.0 (5.0-7.5) and 6.5 (5.0-8.0), respectively. There were significant differences between the pain scores of the three groups (P <0.001, Kruskal-Wallis test). The nurses score was significantly lower than both the parents and the children s scores (P <0.001, Mann-Whitney U test). There was no significant difference between the parents and children s scores (P = 0.11, Mann-Whitney U test). The nurses scored consistently lowest regardless of the cause of the pain or the child s age or gender. Conclusion: Relative to the children and parents, triage nurses assign significantly lower paediatric pain scores. The findings may have important implications for the management of paediatric pain which may need to be based upon the children s or parent s assessment rather than that of the nurse. A? 2009 Paediatrics and Child Health Division (Royal Australasian College of Physicians).