๐Ÿ“Š Tables 93.2 & 93.5 ยท Pediatric Pain Assessment Tools

Nelson Textbook of Pediatrics 22nd Edition โ€” Chapter 93 | Table 93.2: Pain Measurement Tools (FLACC, FACES, NRS, VAS, CRIES, N-PASS, CHEOPS) | Table 93.5: Revised FLACC for Pain Assessment in the Cognitively Impaired (children with disabilities).

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๐Ÿ“‹ Table 93.2 ยท Pain Measurement Tools

ToolAge RangeDescriptionAdvantages / Limitations
FLACC
(Face, Legs, Activity, Cry, Consolability)		2 months - 7 years
(also validated for cognitively impaired)		Behavioral scale (0-10). Each category 0-2. Total score 0-10.Quick, reliable for post-op pain. Overrates pain in toddlers; underrates persistent pain.
FACES Pain Scale - Revised
(FPS-R)		3 years and olderSix faces from no pain (0) to worst pain (10). Child points to face.Easy to use, good psychometrics. Not culturally universal (neutral vs smiling face).
Numeric Rating Scale (NRS)6-8 years and olderIntegers 0 (no pain) to 10 (worst pain). Verbal or written.Requires numerical understanding and ability to conceptualize pain intensity.
Visual Analog Scale (VAS)6-8 years and older10 cm line from 'no pain' to 'worst pain'. Child marks spot.Good for research; requires motor and cognitive skills.
CRIES
(Neonatal)		Neonates (0-6 months)Crying, Requires O2, Increased VS, Expression, Sleeplessness. 0-2 each, total 0-10.Validated for post-op pain in neonates. Vital signs may be influenced by other factors.
N-PASS
(Neonatal Pain, Agitation, Sedation Scale)		Preterm/term neonatesCombined behavioral and physiologic parameters. Scores -10 to +10.Assesses both pain and sedation. Useful in ventilated neonates.
CHEOPS
(Children's Hospital of Eastern Ontario Pain Scale)		1-7 yearsBehavioral scale (cry, facial, verbal, torso, touch, legs). 4-13 points.Valid for acute procedural pain. Time-consuming.
๐Ÿ’ก FLACC score interpretation: 0 = relaxed/comfortable, 1-3 = mild discomfort, 4-6 = moderate pain, 7-10 = severe pain.

๐Ÿ“‹ Table 93.5 ยท Revised FLACC for Pain Assessment in the Cognitively Impaired

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๐Ÿ’ก Revised FLACC for children with cognitive impairment (cerebral palsy, developmental delay, intellectual disability). Score 0-10: 0 = no pain, 1-3 = mild, 4-6 = moderate, 7-10 = severe pain. Important to establish baseline scores for individual child.

๐Ÿ“‹ 30 MCQs โ€” Pain Measurement Tools (Tables 93.2 & 93.5)

๐Ÿ“‡ Highโ€‘Yield Review Cards

๐Ÿฉบ Pain Assessment Scenarios

Select a scenario to identify the appropriate pain assessment tool.

๐Ÿ“‹ Stepwise Approach: Pediatric Pain Assessment

    โšก Reflex Prompts โ€” Pain Assessment Decisions

    ๐Ÿ“– Summary: Pain Measurement Tools โ€” Nelson Tables 93.2 & 93.5

    Source: Nelson Textbook of Pediatrics 22nd Ed โ€” Chapter 93, Tables 93.2 and 93.5. FLACC, FACES, NRS, VAS, CRIES, and revised FLACC for cognitively impaired.
    Category0 points1 point2 points
    FaceNo particular expression or smileOccasional grimace or frown; withdrawn or disinterested (appears sad or worried)Frequent to constant quivering chin, clenched jaw, or distressed expression
    LegsNormal position or relaxedUneasy, restless, tense (occasional tremors)Kicking, or legs drawn up, or marked increase in spasticity/tremors
    ActivityLying quietly, normal position, moves easilySquirming, shifting back and forth, tense (mildly agitated, head back and forth, aggression; shallow respirations, intermittent sighs)Arched, rigid, or jerking movements; severe agitation, head banging, shivering
    CryNo cry (awake or asleep)Moans or whimpers; occasional complaint (occasional verbal outburst or grunt)Crying steadily, screams or sobs, frequent complaints
    ConsolabilityContent, relaxedReassured by occasional touching, hugging, or talking; distractibleDifficult to console or comfort