Although Patient Controlled Analgesia (PCA) pumps have been used in pediatrics >50 years, no studies have examined patient perspectives on PCA usage. This is especially important given that PCAs can now cue opioid availability, which is associated with increased opioid consumption. Study objectives: 1) understand cognitive factors underlying patients' decisions to press the PCA button, and 2) determine whether the cue plays a role in decision making. Participants: 40 youth (16 children/24 adolescents) who used a PCA for ≥ 24 hours post-surgery (M_age= 13.28, 67.5% female, 72.5% White) and their parent. PCAs were programmed so a light on the PCA button was illuminated (green) upon lockout period offset. Qualitative interviews explored factors around PCA usage, and occurred within 36 hours after PCA discontinuation. 92.5% of patients reported PCA use was for pain beyond their manageable threshold and 40% dosed in anticipation of pain. 20% reported that outside factors played a role in their decision to press the button (i.e., getting catheter out, inducing sleep, or prompts from parent(s)/medical providers). 77.5% of patients reported that their decisions were unaffected by the light cue. There were no differences between children and adolescents in cognitive factors underlying PCA use. Parent reports were consistent with patients' perspectives; 82.5% reported that their child did not use the light as a cue. The data suggest that patients primarily use PCA for pain, whether anticipatory or reactionary. Despite the technological advance, the light cue does not appear to be a conscious part of the decision-making process. The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number UL1TR001436. The content is solely the responsibility of the author(s) and does not necessarily represent the official views of the NIH. This project is funded by the Research and Education Program Fund, a component of the Advancing a Healthier Wisconsin Endowment at the Medical College of Wisconsin.