This study explored the relationships among medical fears, coping behaviors, and acute pain perceptions in 17 children with cancer who were encountering a painful medical procedure. The children completed the Child Medical Fear Scale (CMFS) before undergoing a lumbar puncture (LP), which was videotaped. The children's coping behaviors during the procedure were rated independently and classified as active or passive behaviors. Immediately following the LP, the children, using a pictorial scale, reported their pain perceptions. Most of the children's scores on the CMFS indicated a moderately low level of fear of medical experiences. A majority of the children perceived a great deal of pain during the LP. During the five phases of the painful medical procedure, more than half of the children exhibited a combination of active and passive behaviors. No significant differences were found between exhibited active or passive coping behaviors and reported medical fear levels; however, children who exhibited passive coping behaviors reported more pain than those who demonstrated active coping behaviors. Implications for practice relate to the need for continual preparation and support of children during a painful procedure.