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Background: Pain, a subjective experience, poses unique challenges in its assessment, particularly among nonverbal children with intellectual disabilities who express pain in a variety of individualized ways. Traditional pain assessment tools that require verbal participation or only consider typical expressions of pain may inadequately address these children’s needs, leading to inadequate pain management. Objective: Investigate the efficacy of existing pain assessment tools in identifying pain among pediatric patients with barriers to communication due to intellectual disabilities (ID) in a hospital setting. This review aims to provide a nuanced understanding of the current state of the literature on this topic. Methods: A comprehensive search across PubMed, CINAHL, PsycInfo, MEDLINE, and Google Scholar was performed applying the search terms “pediatric”, “pain”, “pain assessment”, “pain management”, “intellectual disability”, “developmental disability”, “mental retardation”, “perioperative”, “preoperative”, “postoperative”, “nonverbal” in various order sequences. No limitations on the year of publication were imposed on the search criteria. Results: This review evaluates the efficacy of currently available individual pain scales for use in children with intellectual disabilities. NCCPC-PV is reliable in this population but has limited clinical utility. The r-FLACC scale has shown reliability and ease of use in the clinical setting. The INRS had shown preliminary validity and reliability, but more research is required. The PPP accurately detects pain, but more research is needed on its reliability and validity. Conclusions: The findings of this literature review contribute valuable insights for healthcare providers and researchers grappling with the complex issues of pain assessment with communication barriers. This review highlights the necessity of continued research for a valid and reliable pain assessment tool in this vulnerable and often overlooked population. Currently, there is no singularly validated pain assessment tool for this population in acute care or hospital settings.