Children with acute musculoskeletal pain caused by traumatic injury often present to emergency departments (EDs). However, there is a tendency for practitioners to underestimate the level and intensity of children’s pain, and there is variation in pain assessments and management. This article discusses the assessment and management of pain in children who attend EDs following acute traumatic limb injury. It uses a case study to illustrate some of the points raised, and offers evidenced-based guidance on assessment and management of children’s pain following acute traumatic limb injury.