The prevalence of pediatric pain, either related to the child's hospital visit or as a result of diagnostic and/or therapeutical interventions, is of primordial importance in pediatric emergency departments (PEDs). In this study, we evaluate the evolution of pain assessment and management in Portuguese PEDs through eleven years. To this end, we prepared a questionnaire addressed to head physicians of 45 the Portuguese PEDs in 2007 and compared the responses to those provided in 2018, where we also posed these questions to nurse managers. Pain assessment in Portuguese PEDs has significantly improved, namely with establishment of local protocols and widespread use of pain scales. However, effective adoption of pain management remains insufficient, as mild to moderate pain is still far from being universally treated. Nonetheless, there seems to be an adequate treatment of severe pain and respective common use of opioids, but correct practices were not generally adopted when specific types of pain were analyzed. Procedural sedation and use of non- pharmacological techniques has significantly increased, but are not yet universally practiced. These inadequacies are reflected by the staff's perception that pain management remains suboptimal, and more training is needed, effectively urging for a nationwide plan and better knowledge translation of correct pediatric pain management.