Pain assessment in critically ill children emphasizes the need to place expert nursing judgment prominently on the list of assessment strategies. The expert nurse is uniquely qualified to identify subtle responses to physiologic and environmental stimuli and to titrate analgesics and other pain relief strategies accordingly. While it is challenging to assess pain with limited verbal and behavioral cues, pain assessment is not only possible, but even more critical, when the available cues are subtle and can be easily overlooked or attributed to other causes. The question that sparked these comments reflects the passion I so often witness in intensive care nurses committed to eliminating pain as an emotional and physiological stressor for these vulnerable children. When that passion is empowered by evidence-based nursing judgment, children receive the best possible care.