Examination of the published literature suggests that a substantial number of children are "undermedicated" for the painful conditions they are being evaluated for in the emergency department (ED). The purpose of this retrospective chart review was to examine the differences between the Agency for Health Care Policy and Research (AHCPR) recommendation for acute pain management and actual analgesic administration for children with known painful conditions, fractures, and burns, at one metropolitan level 1 trauma center. A researcher-developed data collection tool was used to examine demographic information, presenting conditions, documented pharmacologic and nonpharmacologic therapies, and documented analgesic administration to children. Results indicated that in all age groups ( n= 100), children received pain medication for known painful conditions (p=.00). Significance was demonstrated that 14-17 year olds are medicated more often compared with 0-4 year olds (p=.01), 5-9 year olds (p=.02) and 10-13 year olds (p=.04). There was no statistical significance in the use of pharmacological interventions for fractures or burns (p=.10). There was no statistical difference in nonpharmacological pain management measures for fractures or burns (p=. 78). Statistical significance was shown (p=.00) for fractures and burns not receiving adequate initial dosages of analgesics per AHCPR guidelines. These findings were consistent with suboptimal analgesic administration for known painful conditions based on AHCPR recommendations.