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
- FLACC (2 months to 7 years)
| 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| Face | No particular expression or smile | Occasional grimace or frown, withdrawn, disinterested | Frequent to constant frown, clenched jaw, quivering chin |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
- Numeric scale: 5 years and older
