FLACC Pain Scale

Learn how to use the FLACC Pain Scale to assess pain in pediatric patients. Download a free FLACC scale PDF template for quick reference.

By Ericka Pingol on Jul 11, 2024.


Fact Checked by Nate Lacson.

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What is FLACC Pain Scale?

The FLACC Pain Scale is an assessment tool commonly used to evaluate pain, particularly in patients who are unable to communicate their pain verbally. This includes infants, young children, and individuals with communication difficulties. FLACC stands for Face, Legs, Activity, Cry, and Consolability, each being a category used to observe and score a patient's pain level. Here's a breakdown of the scale:

  • Face: Looking for particular expressions such as a constant quivering chin, occasional grimace, or frequent complaints, which can indicate pain.
  • Legs: Observing if the legs are relaxed, uneasy, tense, kicking, or drawn up, which can reflect the intensity of the pain.
  • Activity: Assessing how the patient is lying or sitting, whether they are quiet, moving, or tense and arched, which can be indicative of discomfort.
  • Cry: Listening for no cry, moaning, occasional complaint, or a jerking cry, to gauge the level of pain.
  • Consolability: Determining if the patient is content, reassured, or cannot be consoled, which helps understand the severity of the pain.

Each category is scored on a scale from 0 to 2, with a total possible score of 10. A higher score indicates greater pain intensity. The FLACC scale is particularly useful in pediatric settings, like pediatric intensive care units, and is beneficial for assessing procedural pain or postoperative pain in preverbal patients and nonverbal children.

This scale is valued for its simplicity and effectiveness, and it has undergone various validations and reliability studies. It helps healthcare providers to measure pain objectively and decide on appropriate pain management strategies.

How does this FLACC Pain Scale work?

Download this FLACC Pain Scale and assess your client's changes and improvements.

How the FLACC Pain Scale Works:

  1. Download the FLACC template: You can access our free FLACC Pain Scale template via the link on this page, through the Carepatron app, or our resources library. This tool is a vital part of pain management nursing and health status measurement instruments.
  2. Observe the patient: Assess the patient's behavior using the FLACC scale criteria, focusing on facial expression (smile, occasional grimace, or constant quivering chin), legs (normal position, tense, kicking, or drawn up), activity (lying quietly, occasional touching, or tense and arched), crying (no cry, occasional complaint, frequent complaints, or jerking cry), and consolability (content, relaxed, uneasy, or reassured). This behavioral tool is essential for pain behavioural observation scales, especially for preverbal patient pain scales.
  3. Calculate the patient's score: Assign a score from 0-2 for each parameter, then add up all the scores to determine the patient's overall pain level. This process forms a crucial part of existing behavioral pain assessment tools and helps in procedural pain assessment.
  4. Interpret the result: Typically, a FLACC score of 0 indicates no pain (relaxed and comfortable), 1-3 suggests mild discomfort, 4-6 indicates moderate pain, and 7-10 signifies severe pain. The FLACC scale has shown significant differences in assessing pain in various studies and has been backed by systematic reviews for its criterion validity and inter-rater reliability.
  5. Document the results: Record the FLACC score in the patient's chart, ensuring that the documentation is secure and accessible for future reference. This is especially important in intensive care units and for health practitioners following the Michigan Health System's protocols or similar healthcare frameworks.

FLACC Pain Scale example (sample)

The FLACC scale is a comprehensive, statistically significant, and reliable behavioral pain assessment scale, crucial for observing pain behaviors, particularly in non-verbal patient populations. Its methodological limitations are minimal, and it serves as a significant advancement in pediatric and general pain assessment.

We have created a FLACC Pain Scale example to give you a clear picture of using this free template for your practice. This sample is for a 4-year-old fictitious patient and illustrates the five components and their respective scores. You can view the sample here or download the PDF version for reference.

Download the FLACC Pain Scale example (sample)

FLACC Pain Scale example (sample)

When to use a FLACC Pain Scale PDF?

The FLACC Pain Scale PDF is a valuable resource for healthcare professionals, especially when assessing pain in populations like critically ill patients, preverbal patients, or children in pediatric intensive care units who may not be able to self-report their pain. It's particularly useful in situations where behavioral observation is crucial for pain assessment. Here are some specific scenarios where a FLACC Pain Scale PDF would be highly applicable, integrating the provided keywords:

  • Postoperative pain in children: After surgical procedures, assessing postoperative pain in pediatric patients using the FLACC scale can help in determining the efficacy of pain relief measures.
  • Evaluating acute pain in nonverbal patients: In situations of acute pain where the patient cannot verbally communicate, such as with infants or critically ill children, the FLACC scale provides a structured method to assess pain based on nonverbal indicators.
  • Procedural pain assessment: During or after painful procedures, the FLACC scale can be used to assess procedural pain, helping in deciding whether additional analgesia is needed.
  • Behavioral pain assessment in preverbal patients: For preverbal patients, the FLACC scale allows healthcare providers to assess pain based on behavioral cues like crying, facial expressions, and body movements.
  • Observational pain scales in non-communicative patients: The FLACC scale is an essential tool in environments like intensive care units where patients may not be able to communicate effectively due to their health status.
  • Research and clinical studies: In clinical research, particularly in studies focusing on pain management or the effectiveness of different analgesic interventions, the FLACC scale can be used to provide objective pain scale measurements.
  • Training and education: The FLACC Pain Scale PDF can be a valuable educational tool for training healthcare professionals in assessing and managing pain, especially in pediatric and intensive care settings.

The FLACC Pain Scale PDF typically includes a detailed description of each category (Face, Legs, Activity, Cry, Consolability), instructions on how to score each category, and sometimes a scoring sheet for recording observations. This standardized format ensures consistency and improves the inter-rater and intra-rater reliability of pain assessments.

Who is this Printable FLACC Pain Scale for?

This free FLACC Pain Scale PDF is an effective and reliable tool for evaluating pain in pediatric patients, preverbal children, and adults. It is helpful for:

  • General practitioners
  • Nurses
  • Caregivers
  • Emergency room staff
  • Clinicians
  • Physiotherapists
  • Occupational therapists

You can use this tool in emergency and hospital settings and clinical practice. Additionally, the FLACC Pain Scale can be used as a complementary tool alongside other assessment tools, such as the Wong-Baker Faces Pain Scale.

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Benefits of free FLACC Pain Assessment

Pain assessment tools, including the FLACC scale and other behavioral observation scales, play a crucial role in healthcare, particularly in assessing postoperative pain, acute pain, and procedural pain. They are essential in settings like pediatric intensive care units and for evaluating pain in preverbal patients or critically ill patients. Here's an integration of the provided keywords into the benefits and limitations of these tools:

Benefits of pain assessment tools

  • Objective measurement: Tools like the FLACC scale provide an objective method to assess pain, especially important in nonverbal pain indicators or when self-report is not possible.
  • Improved pain management: By accurately assessing pain, healthcare providers can better tailor pain management strategies, leading to improved patient outcomes, especially in postoperative care or during painful procedures.
  • Enhanced communication: These tools facilitate better communication among healthcare providers about a patient's pain level, improving care coordination in settings like pediatric intensive care units or for critically ill children.
  • Standardization: Pain assessment tools bring standardization to pain evaluation, which is crucial for comparing pain levels over time and across different patients, enhancing the reliability of assessments.
  • Research and clinical Studies: They are valuable in research settings for systematically evaluating the efficacy of pain management interventions, ensuring methodological quality and systematic review of pain management techniques.

Limitations of pain assessment tools

  • Subjectivity in interpretation: Despite their design for objectivity, tools like the FLACC scale can be subject to interpretation variability, affecting inter-rater and intra-rater reliability.
  • Limited scope: Some tools may not encompass all aspects of pain experience, such as emotional or psychological pain, which are important in assessing overall health status.
  • Not universally applicable: Certain scales might not be suitable for all patient populations, like adults with advanced communication skills or patients with specific medical conditions.
  • Training requirements: Effective use of these tools requires proper training. Without it, there's a risk of inaccurate assessments, particularly in interpreting subtle signs like occasional grimaces or tense posture.
  • Potential for overreliance: There's a risk that healthcare providers might rely too heavily on these scales, potentially overlooking other critical aspects of patient care or subtle changes in a patient's condition.

In conclusion, while pain assessment tools like the FLACC scale are invaluable in settings like pediatric intensive care units for evaluating procedural pain and postoperative pain in nonverbal populations, awareness of their limitations is essential for their effective and appropriate use.

You can use this tool in emergency and hospital settings and clinical practice. Additionally, the FLACC Pain Scale can be used as a complementary tool alongside other assessment tools, such as the Wong-Baker Faces Pain Scale.

Why use this FLACC Pain Scale app?

Choose Carepatron for your FLACC Pain Scale assessments to streamline your practice management efficiently. Our comprehensive software is designed to reduce administrative tasks, allowing you to focus more on patient care:

  • Effortless appointment scheduling: Utilize Carepatron's automated scheduling tools for easy booking and managing of patient appointments. This feature ensures quick checking of availability, adding new patients, and rescheduling with just a few clicks.
  • Advanced electronic health records (EHR): Keep patient records organized with our Electronic Health Records (EHR) system. It enables the creation, storage, and updating of digital health records, ensuring up-to-date information is always at hand.
  • Streamlined billing and payment processing: Our software simplifies the invoicing and payment process with billing & payment processing tools. Automated features ensure accurate and efficient financial management.
  • Efficient medical dictation: Save time on documentation with Carepatron's medical dictation feature, allowing you to create notes and reports directly from your voice.
  • Secure online patient portal: Improve patient engagement with our online patient portal, a secure platform for sharing documents, images, and health data.

At Carepatron, we are committed to providing the best practice management software for healthcare professionals. Sign up today and enhance the efficiency and convenience of your practice with our comprehensive platform.

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Merkel S, Voepel-Lewis T, Shayevitz JR, et al: The FLACC: A behavioural scale for scoring postoperative pain in young children. Pediatric nursing 1997; 23:293-797.

What is the FLACC Pain Scale and how is it used for assessing acute pain in preverbal patients?
What is the FLACC Pain Scale and how is it used for assessing acute pain in preverbal patients?

Commonly asked questions

What is the FLACC Pain Scale and how is it used for assessing acute pain in preverbal patients?

The FLACC Pain Scale is a behavioral pain assessment tool specifically designed for non-verbal patients, particularly in pediatric and preverbal patient populations. It evaluates pain based on five criteria: Face, Legs, Activity, Cry, and Consolability. Each criterion is scored from 0 to 2, with a total score ranging from 0 to 10. This scale is essential for assessing acute pain, especially postoperative pain in pediatric intensive care units, where patients may not be able to communicate their pain verbally.

How does the FLACC Scale differ from other pediatric observational pain scales?

Unlike self-report pain scales, the FLACC scale is an observational tool that relies on the observer’s interpretation of the patient's behavior. It focuses on specific behaviors like smile, grimace, leg position (normal or drawn up), activity level (lying quietly or tense and arched), vocalization (occasional complaint or constant crying), and reaction to comfort measures. This makes it significantly different from other pain scales that may require patient verbalization, making the FLACC scale particularly useful in pediatric and preverbal patient care settings.

Can the FLACC Pain Scale be used for procedural pain assessment and what is its reliability and validity?

The FLACC scale is suitable for procedural pain assessment, with studies showing its effectiveness in different clinical settings, including during painful procedures. It has been validated through various research, including systematic reviews that affirm its criterion validity and internal consistency. The scale's inter-rater reliability also ensures that different caregivers can consistently assess a patient’s pain level, making it a reliable tool in health status measurement.

What are the key pain behaviors assessed by the FLACC Scale and how do they indicate pain levels?

The FLACC scale assesses key pain behaviors like facial expression (smile, grimace, or constant quivering chin), leg movement (relaxed, tense, kicking, or drawn up), activity (lying quietly, occasional touching, or tense and arched), crying (occasional complaint, frequent complaints, or inconsolable), and consolability (content, uneasy, or reassured). These behaviors are observed and scored, with higher scores indicating greater pain intensity.

How has the FLACC Scale been adapted for use in various clinical settings like intensive care units?

The FLACC scale has been adapted and validated for use in various clinical settings, including pediatric and general intensive care units. Its versatility allows it to be used in evaluating postoperative pain, monitoring ongoing pain in long-term care, and assessing pain during specific procedures. The scale's methodological simplicity makes it easy to implement in different healthcare settings, from Michigan Health System to small clinics, ensuring wide applicability and utility in pain management nursing.

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