Pain Rating Scales — Pediatric & Non-Verbal
A 3-year-old post-op patient can't tell you their pain is a 7 — but the wrong scale choice means you'll never catch it. Picking the right tool changes outcomes.
Core Concept
Pediatric and non-verbal pain assessment depends on matching the scale to the patient's developmental level and communication ability. For neonates and infants, use behavioral-physiological scales: the FLACC scale (Face, Legs, Activity, Cry, Consolability) scores 0–10 by observing five categories, each scored 0–2. It's also the go-to for cognitively impaired or sedated patients of any age. The NIPS (Neonatal Infant Pain Scale) is used for preterm and term neonates, scoring facial expression, cry, breathing pattern, arm and leg movement, and arousal. For children aged approximately 3–8 years, use self-report tools with visual anchors: the Wong-Baker FACES scale uses six cartoon faces ranging from smiling (0) to crying (10). The child points — you don't interpret the face for them. By age 8 and older, most children can reliably use a standard numeric 0–10 scale. The critical nursing action is documenting which tool was used, reassessing after intervention using the same tool, and never switching scales mid-assessment cycle.
Watch Out For
Don't confuse FLACC (behavioral observation by the nurse) with Wong-Baker FACES (self-report by the child) — FLACC is nurse-scored, FACES requires the child to choose. Students assume crying always equals severe pain on FLACC, but consolability modifies the score — a child who stops crying with comfort scores lower. Wong-Baker is not appropriate below age 3; children under 3 lack the abstract thinking to reliably point to a face representing their pain.
Clinical Pearl
FLACC is what YOU see; FACES is what THEY tell you. Under 3? Observe. Over 3? Let them point. Over 8? Let them number it.
Test Your Knowledge
3 quick questions — see how well you understood Pain Rating Scales — Pediatric & Non-Verbal