Undermanaged procedural pain has been shown to have short and long term effects on children. While significant progress regarding empirically supported treatments has been made, theoretical bases for the development and management of procedural pain are lacking. This paper examines the role of social learning theory in our current understanding of the development, expression, and maintenance of pediatric procedural pain. Social learning theory contributes not only to our theoretical understanding of pain, but also provides insight into the mechanisms of effective treatment. Specifically, the role of self efficacy, its determinants, and the developmental issues are examined. Implications for practice and future research recommendations are discussed.