Sequelae of early pain experience amongst extremely low birthweight (ELBW) children (≤ 1000g) have only been studied indirectly through parent report, which has suggested less pain responsivity at age 18 months, and more somatization at 4½ years amongst ELBW children compared with normal full birthweight (FBW) controls. The aim of the present study was to examine children's judgements about pain at age 8½ yrs., comparing two groups of children who had experienced different exposure to nociceptive procedures in the neonatal period: Group 1, ELBW(n=47; birthweight 808 (540 - 1000)grams; gestation 26.3 (23 - 31)weeks; duration of NICU stay 97 (28 - 240) days); Group 2, FBW (n=37; birthweight 3487 (2614 - 4706)grams; gestation 40 (38 - 42)weeks). Based on the premise that individuals' perceptions of pain in others reflect their own experiences, the children judged 24 pictures depicting pain in 4 types of settings: medical, recreational, daily living, and psychosocial (Pediatric Pain Inventory, Lollar DJ et al. J Ped Psychol 1981; 7:267-277). The subjects rated pain intensity using both a pain thermometer and a faces scale. The ratings on the two scales were moderately correlated for settings depicting physical pain (r = 0.53 to 0.68, p = 0.001 to 0.0001), but not psychosocial (r = 0.24, p = 0.15). Univariate repeated measures analysis of covariance was carried out, with IQ and mother's education as the covariates. Pain related to activities of daily living and recreation was significantly higher than psychosocial and medically related pain on both scales in both groups of children (p = 0.0001). Although the two groups of children did not differ overall in their perceptions of pain, the ELBW children rated medical pain significantly higher than psychosocial pain using the pain thermometer (p = 0.004). Also, duration of NICU stay for the ELBW children was slightly correlated with their ratings of pain in recreational and daily living settings, but only for the faces scale (p = 0.01 to 0.04). Despite marked differences in response to pain in the early years reported by parents, on the whole at 8½ years ELBW children appear to judge pain in others similarly to their term peers.