Pediatric Pain Scales Presented by: Danyel Dorn RN, MSN, CPN, Clinical Nurse Educator-Pediatric Service Line

Purpose Pain is often observed in the perianesthesia setting and nurses must be able to assess the patient’s age or cognitive ability. It is essential that perianesthesia registered nurses caring for pediatric patients develop competency and expertise in application of appropriate pain scales to assess pain in children.

Competency Statement The perianesthesia registered nurse caring for the pediatric patient will be able to identify and understand the various pain scales described an utilize them correctly according to the patient’s growth and developmental needs.

Pain Scales The following slides are a few of the pain scales that are offered to assess the pain in a pediatric patient. Please refer to CRMC policy when choosing a pain scale that is most appropriate for the pediatric patient.

The CRIES Scale Used for children between 32-60 weeks gestational age Criteria for the scale include: crying, oxygen requirements, increased vital signs, expression and sleeplessness Score ranges for each of the criteria from 0-2 The total possible score in the CRIES scale is 10

The POPS Scale The Postoperative Pain Score is appropriate for children between 1-7 months of age The ten variables of the POPS scale include sleep, flexion of fingers/toes, facial expression, sucking, quality of motor activity, consolability, spontaneous excitability and sociability Each variable is rated 0-2 where a low total score demonstrates the worst pain and a high total score (up to 20) demonstrates no pain

The FLACC Scale FLACC = Face, Legs, Activity, Cry, Consolability Useful up until the age of 7 Each of the 5 variables of the FLACC scale is measured as 0-2 (0,1,2). The total of the 5 variables added together document the overall score that ranges from 0-10. The FLACC scale should be used for older children who are unable to adequately verbalize pain scale such as the Wong-Baker FACES scale

The Wong-Baker Faces Scale The FACES pain Scale is a self-reported pain assessment toll developed by Wong and Baker that utilizes cartoon faces with a range of expressions from sad to happy. There are generally six faces represented that correspond to increasingly worse pain. The pain score can be interpreted in a range (where each face equals 2,4, 6, 8 or 10. The FACES scale is the only scale that includes graphics to aid in accurate reporting of pain. Although self-reported pain is often considered the gold standard, the patient’s emotions and developmental age should be considered when assessing the pain level in children.

The Numeric Scale The numeric pain scale is a scale representing the amount of pain felt numerically from 0-10. The numeric pain scale may be used in children as young as 5 who knows how to count.

Reference ASPAN (2016). A Competency Based Orientation and Credentialing Program for the Registered Nurse Caring for the Pediatric Patient in the Perianesthesia Setting.

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