Pain management in children with cancer continues to be less than adequate in most settings. Children in pain often have multiple caregivers, each imposing a significant risk to adequate pain management if they are uninformed about the principles of pain management and the child’s specific pain management regimen. This article reviews current pain management guidelines for children, obstacles to adequate pain management, and the challenges of managing pain across care settings (hospital to home). Using the hospice model of care, case studies are presented that illustrate both threats to adequate pain control and the coordination of care necessary to ensure consistent pain management between the hospital and home. Implications for improvement in pain management between settings and future directions for advancing skills and knowledge related to pain management in children with cancer are provided.