Kahsay
Curr Pediatr Res 2017 Volume 21 Issue 1
150
after
observing the infant for 1 min. Among two observers
a reliability of FLACC was established in a total of 30
children in the post anesthetics care unit (PACU) (r=0.94).
After analgesic administration, validity was established
by demonstrating a proper decrease in FLACC scores.
Correspondingly, a high degree of association was found
between PACU nurse’s global pain rating scale, FLACC
scores, and with the objective scores of pains scale. This
tool has been established in various settings and in diverse
patient populations and finds that as reliable and valuable.
It provides a simple background for computing pain
behaviors in children who may not be able to put into words
the incidence or severity of pain. Lastly, the constructed
validity is supported by analgesic administration as the
scores decreases significantly. Another recent studies
have demonstrated that FLACC was the most chosen in
terms of sensible qualities by clinicians at their respective
institutions [27,29,32-35]. Although the tool can be
used by clinicians, it is more effective with parent input
to provide a description of ‘baseline’ behavior. This is
supported by the findings of the Malvinas study, which
suggested that the addition of unique descriptors allowed
parents to augment the tool with individual behaviors
unique to their children. In addition, for infants who show
good comprehension and motor skills, this pain assessment
tool can be used as an alternative [36]. The FLACC scale
has 98% sensitivity and 88% specificity in assessing pain
levels [34]. Therefore, those different studies concluded
that FLACC scale is the most appropriate measurement
tool for pain assessment in infants (Table 3).
Cries Pain Rating Scale
0
1
2
Crying
No
high pitched
inconsolable
Requires O
2
for sat >95%
No
<30%
>30%
Increased vital signs
HR and BP <or=pre-op
HR and BP;
Increased <20% of
pre-op
HR and BP; Increased >20% of
pre-op
Expression
None
Grimace
Grimace/grunt
Sleepless
No
Wakes at frequent
intervals
Constantly awake
Table 2.
Neonatal pain rating scale [27-29]
children
and across all settings. Individual needs of the
children lead to assess and re-evaluate of pain consistently
as a mandatory in every situation. On top of that,
ethnicity, language, and cultural factors should be under
consideration as they may influence pain assessments and
its expression [5,12,26].
Most formal and commonly used means of pediatric
assessment tools for pain are available and categorized
depending the pediatrics age.
Pain Assessment in Neonates
Neonates pain rating scale (NPR-S):
Major guidelines
indicate that the assessment of pain in neonates (term
babies up to 4 weeks of age) had better be use the
C
rying,
R
equires oxygen for saturation above 95%, Increasing
vital signs, Expression and Sleepless (CRIES) scale
(Table 2) [2,24,27-30].
Several other pain scales have been designed for the
objective assessment of neonatal pain, including the
COMFORT (“behavior”) score, pain assessment tool, scale
for use in newborns, distress scale for ventilated newborns
and infants. Although these assessments are validated as
research tools, the mainstay of appropriate management
includes the caregiver’s awareness, knowledge of clinical
situations where in pain occurs, and sensitivity to the
necessity of preventing and controlling pain [31].
Assessment of pain in infants:
On a study in Australia
hospitals, Infants (1 month to approximately 4 years) were
scored using the face, leg, activity, cancelabilit
y and cry
(FLACC) measuring tool. Scoring should be done by staff
FLACC Behavioral Pain Assessment Tool
0
1
2
Face
No particular expression
or smile
Occasional grimace/frown withdrawn or
disinterested
Frequent/constant quivering
chin, clenched jaw
Legs
Normal position or
relaxed
Uneasy, restless or 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
Moans or Whimpers, occasional complaint Crying steadily, screams or
sobs, frequent complaints
Cancelability
Content or relaxed
Reassured by occasional touching,
hugging or being talked to, distractible
Difficult to console or comfort
Table 3.
FLACC assessment tool [27,29,32-35]
