Pain Assessment in Infants & Children

Observational Pain Scales for Neonates and Infants

With the widespread use of screening blood tests in the newborn and the large number of neonatal circumcisions performed in hospitals throughout the U.S., researchers have been developing assessment tools and studying the effects of pain in newborns for a number of years.⁷ These pain assessment scales have been validated in studies of preterm and term neonates and have aided in the development of similar observational scales for toddlers and cognitively impaired children. Most combine easily obtained physiologic parameters such as heart rate and oxygen saturation with facial expressions such as brow bulge, eye squeeze, and nasolabial furrow and body movements to determine the degree of discomfort. The most commonly used scales in newborns are the Premature Infant Pain Profile (PIPP) and the CRIES Postoperative Pain Scales.^7-9 The FLACC (Face, Legs, Activity, Cry and Consolability) Scale is a behavioral scale that has been validated for assessment of postoperative pain in children between the ages of 2 months and 7 years.¹⁰ After observing a child for one to five minutes, a pain score is obtained by reviewing the descriptions of behavior and selecting the number that most closely matches the observed behavior.