Text Size

  • Increase
  • Decrease
  • Normal

Current Size: 100%

FLACC Scores

FLACC Score

A frequent challenge in pediatrics is assessing pain in children who are non-verbal. Part of this population is unable to report the location and degree of their pain because of chronological age, i.e. an infant or toddler. Another significant group is the population of children with cognitive impairment that is severe enough to impair their expressive language. This population includes but is not limited to children with severe cerebral palsy, developmental delay, or mental retardation.

The FLACC score has been validated for measuring postoperative pain in children with mild to severe cognitive impairment. It has also been validated for the assessment of pain secondary to surgery, trauma, cancer or other painful diseases for all pre-verbal children (including infants).

In the diagram below are the categories for scoring. Zero, one or two points is assigned to each of the five categories shown in the table: Face, Legs, Activity, Cry, and Consolability (hence the term, FLACC). Total points assigned may be from zero to ten.

As discussed above, the numeric rating scale may be categorized into no pain, mild pain, moderate pain, and severe pain based on the 0-10 self report scale. The categories guide analgesic selection when the score is obtained by self-report. In contrast, the total FLACC score (0-10) cannot be converted to these descriptive groupings. The score should be contextualized to the particular patient, the clinical setting and his/her primary caregiver's perception of the child's behavior. A patient with developmental delay may need an opioid for pain relief but have a FLACC score that is less than seven. 

CATEGORIES

SCORING

 

0

1

2

FACE

No particular expression or smile

Occasional grimace or frown, withdrawn, disinterested.

Frequent to constant quivering chin, clenched jaw.

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 being talked to, distractable.

Difficulty to console or comfort

References:

Hicks CL et al The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement. Pain, 2003;93:173-183.

Manworren RCB, Hynan LS Clincal Validation of FLACC: Preverbal patient pain scale. Pediatric Nursing, 2003;29:140-146.

Voepel-Lewis T et al The Reliability and validity of the face, legs, activity, cry, consolability observational tool as a measure of pain in children with cognitive impairment, Anest Analg 2002;195: 1224-1229.

Chapter 8 in Pain in Infants, Children, and Adolescents, 2nd edition edited by Schechter, Berde and Yaster, and published in 2003 was a valuable source of information and references for this column.