Background and Objectives: Although racial disparities in pediatric pain have been described, family-centered research is lacking. This mixed-methods study aimed to understand race-specific factors impacting acute pain experiences in Non-Hispanic White (NHW) and Black (NHB) children. Methods: NHW and NHB children (aged 8-17) (n=19 each) with a recent acute pain experience, and their caregivers were recruited. The following domains were assessed in children (deprivation, ethnic identity, pain, psychosocial, pain coping, resilience) and caregivers (education, income, Racial and Ethnic Microaggressions Scale (REMS), Adverse Childhood Events (ACEs), Adult Response to Childs Symptoms). Questionnaire measures were compared between groups using simple statistical tests. Fifteen dyads participated in focus groups. Thematic codes underlying pain experiences were identified. Results: NHB children had similar pain/psychosocial characteristics but differed in ethnic identity (2.7 (0.5) vs. 2.2 (0.5); P=.002), deprivation index (0.4 (IQR 0.3-0.5) vs. 0.3 (IQR 0.2, 0.3), P=.007) and pain coping efficacy (8.6 (0.4) vs. 9.8 (0.5), P=.045) from NHW children. NHB caregivers scored higher on REMS sub-scales, ACEs (0 (0,1) vs 0 (0,0); P=.02) and Protection (1.9 (0.6) vs. 1.6 (0.5); P=.03) behaviors in response to child pain. NHB and NHW participants endorsed satisfaction with pain experiences, opioid avoidance, and stoicism. Unlike NHW participants, NHB reported barriers related to trust, discrimination, and access. Conclusions: Racial differences in acute pain experiences suggest healthcare providers need to reinforce trust and consider underlying cultural and pain coping differences when treating pain in NHB children. Findings emphasize that family-centered and systems-based approaches are important for equity in pediatric pain.

The authors have declared no competing interest.

Center for Clinical & Translational Science & Training Integrating Special Populations Health Grant

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Cincinnati Children's Hospital IRB

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors.