Purpose: The purpose of this cross-sectional descriptive study was to determine the relationship between pain frequency, walking activity, and participation with sickle cell disease (SCD). Methods: A cross-sectional descriptive study observed a cohort of 50 children with SCD, ages 6-13 years, who attend school. Participants wore the Fitbit Flex wireless activity monitor to track step counts for four weeks. They completed pain diaries and testing with the Beery-Buktenica Developmental Test of Visual-Motor Integration, and the Assessment of Life Habits. Descriptive statistics representative of the study sample were summarized relative to data type. Correlation analysis of data was used to measure the strength of association beteween pain frequency, walking activity, and participation. Results: The negative relationship between pain frequency and participation was moderately correlated and statistically significant. The positive relationship between walking activity and participation was moderately correlated and statistically significant. No significant relationship was found between pain frequency and walking activity. Conclusion: Pain frequency and walking activity influence ability to participate in life habits for children with SCD. Future pediatric physical therapy research to examine interventions to modulate pain and increase walking activity could have implications for participation in life habits among children with SCD.