There is a lack of knowledge regarding the implementation of pain assessment tools for children with profound neurological impairment (PNI) in in-patient settings. This article describes a pilot project to evaluate the Paediatric Pain Profile (PPP) for children with PNI undergoing surgery. Five families of children 5 to 16 years of age with a primary diagnosis of cerebral palsy and admitted for surgical procedures were interviewed. Nineteen nurses completed questionnaires and children’s pain management documentation was audited. The project identified issues in three areas of pain management: implementation process, individualised pain management and partnership. The PPP required pre-admission assessment and parental involvement, and was considered time-consuming by nurses. Individualised pain assessment and intervention was difficult to achieve, as was shared assessment and documentation among parents and nurses. Despite initial resistance to change, with greater use there was growing appreciation of the value of components of the PPP. Further exploration of the PPP tool in practice is required before its use can be widely recommended for children with PNI in in-patient settings. Future studies are required to determine which of the available pain assessment tools has the greatest accuracy and utility for assessment of post-operative pain in children with PNI.