FLACC Scale: All You Need to Know About FLACC Scale Pain

flacc-scale
Photo Credit: Gettyimages

FLACC is a behavioral pain assessment scale used for nonverbal or preverbal patients who cannot self-report their pain levels.

This pain assessment can be presented in a chart.

Although there are different pain assessments, FLACC seems unique and straightforward.

This article tends to enlighten you on how FLACC Scale works and relates to other pain scales you may find helpful.

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What is FLACC Scale?

The FLACC scale stands for Face, Legs, Activity, Cry, and Consolability. It is one of the most regularly used behavioral observation pain measures for children aged two months to 7 years and those unable to air out their pain.

According to Wikipedia, the FLACC scale has also been useful when used with adults in intensive care units (ICU) who cannot talk due to intubation.

What Does FLACC Measure?

FLACC is a behavioral pain assessment measure for individuals who are nonverbal or preverbal and unable to self-report their level of pain.

So, pain is assessed by observing five categories: face, legs, activity, cry, and consolability.

Furthermore, A revised version (rFLACC) covers behaviors specific to children with cognitive impairments.

What is the FLACC Scale Age Range and the Target Population?

Infants and children from 2 months to 18 years are eligible for the FLACC scale.

Then there are children with mild to severe cognitive impairments, developmental delays, and cerebral palsy among the target groups.

Furthermore, values are used to interpret postoperative pain in children with mild to severe cognitive problems and pain in preverbal children caused by trauma, surgery, cancer, and other disorders.

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FLACC Pain Scale Chart

The table shows the FLACC Pain Scale requirements:

CriteriaScore 0Score 1Score 2
FaceNo particular expression or smileOccasional grimace or frown, withdrawn, uninterestedFrequent to constant quivering chin, clenched jaw
LegsNormal position or relaxedUneasy, restless, tenseKicking or legs drawn up
ActivityLying quietly, normal position moves easilySquirming, shifting, back and forth, tenseArched, rigid, or jerking
CryNo cry (awake or asleep)Moans or whimpers; occasional complaintCrying steadily, screams or sobs, frequent complaints
ConsolabilityContent, relaxedReassured by occasional touching, hugging, or being talked to, distractibleDifficult to console or comfort
FLACC Pain Scale Chart

What is the Form of Evaluation When Using the FLACC Scale?

Patients Who are Awake:

  • Keep an eye on everything for at least 2-5 minutes.
  • Examine the exposed legs and body.
  • Reposition the patient or monitor the activity; also, check the patient’s body for tenseness and tone.
  • If necessary, initiate consoling interventions.

Patients Who are Asleep:

  • Watch for at least 5 minutes, preferably longer.
  • Examine the exposed body and legs.
  • Reposition the patient if possible.
  • Examine the body for tenseness and tone.

Assessment of FLACC Pain Score

The score of the scale is from 0 to 10, with 0 indicating no pain. The scale also comprises five categories, each with a value of 0, 1, or 2, as shown in the chart above.

  • 0 = Relaxed and comfortable
  • 1-3 = Mild discomfort
  • 4-6 = Moderate pain
  • 7-10 = Severe discomfort/pain

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8 Most Common Types of Pain Scales: Printable

There are different types of pain scales available to healthcare professionals. Indeed, they are often classified into one of three types:

  • NRS (numerical rating scales): Use numbers to rate pain
  • Visual analog scales (VAS): Choosing an image that best represents your pain level is the direct question in this scene.
  • Categorical scales: Use words mostly, possibly with numbers, colors, or bodily locations.

1]. Numerical Rating Pain Scale

Numerical Rating Pain Scale
Numerical Rating Pain Scale

The Numerical Rating Scale (NRS) is designed for anyone above the age of 9. Also, It is one of the most widely used pain scales in medicine.

Therefore, to use it, simply speak the number that best describes your degree of pain; you may even leave a mark on the scale itself.

Finally, a value of 0 indicates no pain, while a value of 10 indicates the most intense pain possible.

2]. Wong-Baker Faces Pain Scale

Wong-Baker Faces Pain Scale
Wong-Baker Faces Pain Scale

For pain ratings, the Wong-Baker FACES Pain Scale mixes images and numbers.   It is ideal for adults and children over the age of three.

As a result, six different expressions are represented by six different faces, ranging from happy to highly unhappy. Each certainly has a number rating ranging from 0 (smiling) to 10 (crying).

You may also use it by pointing to the image that best depicts the degree and intensity of your pain.

Related: PQRST Pain Assessment Method: How it Works

3]. FLACC Pain Scale

FLACC Pain Scale
FLACC Pain Scale

The FLACC Pain Scale is based on a healthcare provider’s observations. In fact, it was originally designed to assess young children. It may now be used to assess anybody who is unable to talk.

4]. CRIES Pain Scale

what is the flacc pain scale
CRIES Pain Scale

The CRIES Pain Scale assesses: 

  • Crying
  • Oxygenation
  • Vital signs
  • Facial expression
  • Sleeplessness

As a matter of fact, it is commonly used for newborns aged 6 months and under. It’s certainly, common in neonatal intensive care units (NICU).

Therefore, this evaluation method is based on observations and objective measures made by a healthcare practitioner. 

  • A score of 0 indicates that you are not in pain.
  • A score of 2 indicates that you are in severe pain.

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5]. COMFORT Pain Scale

COMFORT Pain Scale

Based on nine separate characteristics, the COMFORT Scale assigns a pain level between nine and 45. Therefore, each rate is on a scale of 1 to 5:

  • Alertness: one for deep sleep, two for light sleep, three for sleepiness, four for alertness, and five for extreme alertness.
  • Calmness: 1 for total calm, also higher ratings for increased anxiety and agitation.
  • Respiratory distress: How much your breathing suggests pain, with turbulent breathing receiving higher scores.
  • Crying: score 1 for no crying, higher for moaning, sobbing or screaming.
  • Physical movement: a score of 0 indicates no movement (a symptom of reduced pain), a score of 1 or 2 indicates some movement, and a higher number indicates severe movement (e.g., thrashing in pain)
  • Muscle tone: A score of 3 indicates normal muscle tone, lower numbers indicate reduced muscle tone, and higher levels indicate rigid muscles.
  • Facial tension: 1 for a perfectly normal, calm face; and higher values for signs of strain.
  • Blood pressure and heart rate: calculated using your baseline; 1 indicates they are below baseline (abnormally low), 2 indicates they are at baseline, and higher scores indicate increased or abnormally high levels.

It should be noted that the COMFORT Measure is another pain scale created for persons who are unable to define or rate their pain, such as:

  • Children
  • Adults with mental impairments
  • Adults momentarily hampered by medicine or sickness
  • Sedated patients in an intensive care unit (ICU) or operating room

6]. Color Analog Pain Scale

Flacc Scale
Source: Gettyimages

The Color Analog Scale (CAS) is a pain scale that uses colors to indicate different levels of pain:

  • Red: Severe pain
  • Yellow: Moderate pain
  • Green: Comfortable

The colors are set in a row with numbers or words that express your pain. As a result, the Color Analog Scale is a popular and reliable tool for children.

Related: FUGL Meyer Assessment of Motor Recovery After Stroke PDF Form

7]. Brief Pain Inventory

Brief Pain Inventory

The Brief Pain Inventory (BPI) is a 15-question worksheet.
You are asked to assess the degree of your pain in numbers,  in categories such as:

  • How you interact with others
  • Your walking ability
  • How you sleep in the previous 24 hours

In fact, this pain rating is more subtle in terms of how your pain affects your daily life.

8]. Defense and Veterans Pain Rating Scale

Defense and Veterans Pain Rating Scale

In 2021, the United States Department of Defense announced the use of a new pain measure known as the Defense and Veterans Pain Rating Scale (DVPRS).

As a matter of fact, according to a news release, it is the result of both healthcare practitioners and people’s unhappiness with previous pain indexes. Rather than a basic scale, it includes:

  • Faces: Expressions range from happy to sad.
  • Colors: Green represents no pain, while red represents the worst potential suffering.
  • Numbers: 0 for no pain, 10 for the most severe pain possible
  • Descriptors: “hardly notice pain,” “hard to ignore, avoid regular activities,” and “can’t endure the pain, unable to do anything” are some examples.

Frequently Asked Questions

What is a Flacc pain scale?

FLACC is a behavioral pain assessment measure for individuals who are nonverbal or preverbal and unable to self-report their level of pain.

What age group uses Flacc?

Infants and children from 2 months to 18 years are eligible for the FLACC scale.

How do I use Flacc?

Keep an eye on it for at least 2-5 minutes.
Examine the exposed legs and body.
Reposition the patient or monitor the activity; check the patient’s body for tenseness and tone.
If necessary, initiate comforting interventions.

Can Flacc be used for adults

Yes, the FLACC scale has also been shown to be reliable when used with adults.

What is the pain scale used for newborns?

The Neonatal Infant Pain Scale (NIPS)

Conclusion

The FLACC scale has also been shown to be reliable when used with adults in intensive care units (ICU) who are unable to talk due to intubation.

Furthermore, the FLACC scale provides the same pain rating as the Checklist of Nonverbal Pain Indicators scale, which is used in ICUs.

Reference

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