Pediatrics : Pain Assessment

Pain Assessment

  • Intensity
    • Assessment includes behavioral measures, multidimensional, and self-report.
    • Self-report is used for children 4 years or older. Children under 4 are unable to accurately report their pain
    • Multiple tools have been developed and researched as reliable
    • Choose an appropriate pain tool that will adequately assess the infant or child’s pain
    • Assess the location, quality, and severity of pain
  • Satisfaction with treatment
  • Symptoms and adverse events
  • Physical recovery
  • Emotional response
  • Behavioral pain measures
    • FLACC (2 months to 7 years)
      • Pain rated on a scale of 0 to 10
      • Assess behaviors of the child
Ages of Use  Reliability and Validity Variables Scoring Range
FLACC Postoperative Pain Tool
2 months of age to 7 years of age Validity using analysis of variance for repeated measures to compare FLACC scores before and

after analgesia; preanalgesia FLACC scores significantly higher than postanalgesia scores at

10, 30, and 60 minutes (p <0.001 for each time)

Correlation coefficients used to compare FLACC pain scores and OPS pain scores; significant

positive correlation between FLACC and OPS scores (r = 0.80; p <0.001); positive correlation also

found between FLACC scores and nurses’ global ratings of pain (r[47] = 0.41; p <0.005)

Face (0–2)

Legs (0–2)

Activity (0–2)

Cry (0–2)

Consolability (0–2)

0 = no

pain; 10 = worst pain

FLACC Scale
FLACC 0 1 2
Face No particular expression or smile  Occasional grimace or frown, withdrawn, disinterested Frequent to constant frown, clenched jaw, quivering chin
Legs Normal position or relaxed  Uneasy, restless, tense Kicking, or legs drawn up
Activity Lying quietly, normal position, moves easily  Squirming, shifting back and forth, tense Arched, rigid, or jerking
Cry No cry (awake or asleep)  Moans or whimpers, occasional complaint Crying steadily, screams or sobs, frequent complaints
Consolability  Content, relaxed Reassured by occasional touching, hugging, or talking to; distractible Difficult to console or comfort
    • Numeric scale: 5 years and older
      • Pain rated on a scale of 0 to 10
      • Explain to the child that 0 means “no pain” and 10 means “worst pain”
      • Have the child verbally report a number or point to their level of pain on a visual scale
    • FACES
      • Pain rated on a scale of 0 to 5 using a diagram of six faces.
      • Substitute 0,2,4,6,8,10 for 0 to 5 convert to the 0 to 10 scale
      • Explain each face to the child; ask the child to choose a face that best describes how they are feeling
        • 0: No hurt
        • 1: Hurts a bit
        • 2: Hurts a little more
        • 3: Hurts even more
        • 4: Hurts a whole lot
        • 5: Hurts worst
    • Oucher: 3 to 13 years
      • Pain rated on a scale of 0 to 5 using six photographs
      • Substitute 0,2,4,6,8,10 for 0 to 5 convert to the 0 to 10 scale
      • Have the child organize the photographs in order of no pain to the worst pain; ask the child to choose a picture that best describes how they are feeling.
        • 0: No hurt
        • 1: Hurts a bit
        • 2: Hurts a little more
        • 3: Hurts even more
        • 4: Hurts a whole lot
        • 5: Hurts worst

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