Consensus, divergence, and challenges in pediatric pain management practices: a qualitative study from a multi-stakeholder perspective

Abstract Background Effective pediatric pain management relies on accurate assessment, yet timely and effective assessment remains a global challenge. This is particularly pronounced in China, where a significant gap exists between guidelines and clinical practice. The perspectives of key stakeholders, including children, parents, and medical staff, are crucial but underexplored in an integrated manner. Methods A descriptive qualitative study was conducted, informed by the Health Belief Model. Through purposive sampling, semi-structured interviews were held with pediatric surgical patients, their parents, clinicians, and nurses at a tertiary children’s hospital in Chongqing, China. Data collection continued until thematic saturation was reached. Thematic analysis was used to analyze the data. Results Thirty-five participants were included (12 medical staff, 12 parents, 11 children). Analysis revealed five core themes: (1) Consensus on systemic underestimation of pain; (2) Multilevel consequences of unaddressed pain; (3) Group-specific barriers to effective assessment; (4) Divergent visions for ideal solutions; (5) Convergent enablers for change. These themes delineate a tripartite misalignment among stakeholders: while all groups agreed on the problem and its seriousness, their diagnoses of causes and visions for solutions diverged fundamentally across systemic, relational, and experiential dimensions. This misalignment itself constitutes a core, self-reinforcing barrier to effective pain assessment. Conclusion This study identifies a critical tripartite misalignment among stakeholders in pediatric pain assessment, manifested across systemic, relational, and technological dimensions. A key driver of this misalignment and the persistent underestimation of pediatric pain is the diffusion of professional responsibility and the marginalization of pain assessment in clinical practice. The findings underscore the necessity for integrated interventions that not only address these interdependent dimensions but also explicitly aim to improve professional awareness, clarify accountability, and elevate the priority of pain management. Future research should focus on developing and evaluating such multifaceted strategies across diverse clinical settings.