To summarize briefly, impaired functioning in all domains is a major and potentially a long-term problem for children with recurrent or chronic pain and their families, which are a significant segment of the American population. Children show significant variations in their ability to cope with pain and continue to function, and some children learn better functioning over time. The child's own sense of self-competence, or task-specific self-efficacy, is one important factor which may reinforce or moderate the child's functioning. Functional disability is clearly associated with psychosocial distress. But these factors are also mutually reinforcing; while children with more psychosocial distress may have more problems functioning with pain, certainly children who experience pain and attendant functional problems are likely to react with anxiety and/or depression.