Postoperative pain management is complex especially in the pediatric population where limited research exists to guide clinical practice. We currently cannot predict which children are at the greatest risk for pain, persistent postoperative pain, adverse analgesic effects, or opioid addiction. Instead, pain medications are prescribed based on perceived seriousness of the patient’s illness/procedure, with little regard for individual genetic suitability. For the pediatric patient, personalized medicine has the potential to improve pain management and reduce risks of adverse analgesic effects, including opioid addiction. The purpose of this review article is to inform pediatric surgical nurses about the current status of genetic research related to pain sensitivity, genetic variants that affect analgesic metabolism, and the genetics of addiction. Application of this information in clinical practice remains merely a possibility; yet, vendors have begun to market genetic testing without clear guidelines for clinical interpretation. Genetic research efforts are progressing at a rapid pace, and the pediatric surgical specialist must be aware of both the potential implications for postoperative pain management as well as the current limitations given the level of research that is available to guide practice.