In this paper I aim to show why pediatric suffering must be understood as a judgment or evaluation, rather than a mental state. To accomplish this task, first I analyze the various ways that the label of suffering is used in pediatric practice. Out of this analysis emerge what I call the twin poles of pediatric suffering. At one pole sits the belief that infants and children with severe cognitive impairment cannot suffer because they are nonverbal or lack subjective life experience. At the other pole exists the idea that once child suffering reaches some threshold it is ethical to eliminate the sufferer. Concerningly, at both poles, any particular child vanishes from view. Second, in an attempt to identify a theory of suffering inclusive of children, I examine two prominent so-called experiential accounts of suffering. I find them both wanting on account of their absurd entailments and their flawed assumptions regarding the subjective experiences of people who cannot communicate expressively. Finally, I extend arguments found in Alastair MacIntyre’s Dependent Rational Animals to argue that child suffering can be understood only as a set of absences—absences of conditions such as love, warmth, and freedom from pain. An evaluation of these absences reveals the exquisite dependency of children. It also discloses why pediatric suffering is necessarily a social and political event. Unlike adults, children will never be either the authors or the mitigators of their own suffering. Rather, children must rely wholly on others in order to resist suffering, grow, and flourish.

在本文中，我旨在说明为什么必须将儿科痛苦理解为一种判断或评估，而不是一种精神状态。为了完成这项任务，我首先分析了在儿科实践中使用痛苦标签的各种方式。从这个分析中产生了我所说的儿科痛苦的两极。一个极端的信念是，患有严重认知障碍的婴儿和儿童不会受苦，因为他们不会说话或缺乏主观生活经验。在另一极存在这样的想法，即一旦儿童的痛苦达到某个阈值，消除受害者是合乎道德的。令人担忧的是，在两极，任何特定的孩子从视野中消失。其次，为了确定一种包括儿童在内的痛苦理论，我研究了两个著名的所谓的痛苦经验说明。我发现他们都因为他们荒谬的蕴涵和他们对无法表达交流的人的主观体验的错误假设而缺乏。最后，我扩展了在 Alastair MacIntyre 的Dependent Rational Animals中发现的论点争辩说，儿童的痛苦只能被理解为一系列缺席——诸如爱、温暖和免于痛苦等条件的缺席。对这些缺席的评估揭示了儿童的精致依赖。它还揭示了为什么儿科痛苦必然是一个社会和政治事件。与成年人不同，儿童永远不会成为自己痛苦的作者或减轻者。相反，孩子们必须完全依赖他人才能抵抗痛苦、成长和繁荣。