BACKGROUND: A total of 80% of children experience postoperative pain following discharge. Effective postoperative pain management involves reliable caregiver pain assessment and/or child self-report of pain. Unfortunately, caregiver and child ratings of postoperative pain are not always consistent (i.e., concordant). This study aimed to identify postoperative pain concordance among caregiver-child dyads and predictors for postoperative pain discordance. METHODS: Children and their caregivers completed preoperative baseline demographic, anxiety, and distress measures. Postoperatively, children and caregivers completed pain severity ratings using the Child Health Rating Inventories (CHRIS 2.0). On the basis of postoperative pain scores, caregiver-child dyads were classified as overestimators (i.e., caregivers rated pain as higher than children), in agreement, or underestimators (i.e., caregivers rated pain as lower than children). RESULTS: A large proportion of dyads disagreed on pain ratings (n = 104
44%), with 64 (27%) caregivers classified as overestimators and 40 (17%) caregivers classified as underestimators. Caregivers were more likely to underestimate male children's pain, β = 1.238, OR = 3.35 (95% CI: 1.26, 9.43), p = 0.16, and Spanish-speaking Latinx caregivers were more likely to underestimate children's pain, β = 2.27, OR = 9.63 (95% CI: 2.35, 39.37), p = 0.002. CONCLUSION: Although most caregiver-child dyads agreed with pain ratings, 44% of the dyads disagreed. Among those who disagreed, males from Spanish-speaking Latinx households were at greatest risk of having their pain underestimated by their caregiver, which could be explained by the influence of intersecting social identities on pain beliefs, expression, and behaviors. Future studies should explore how pain discrepancies influence postoperative recovery outcomes for Latinx children.