Flacc Scale: Assessing Non-verbal Pain

Imagine how difficult it is to understand the severity of pains in people who are unable to communicate their pains and children between ages 2 months and 7 years, it’s quite tasking and stressful, right?

Quick Facts About FLACC Scale

A	B
Full Name	FLACC Scale (Face, Legs, Activity, Cry, Consolability)
*Purpose*	To assess pain in young children and individuals unable to communicate their pain verbally
*Developed By*	Sandra Merkel, MS, RN, and colleagues at the University of Michigan Health System
*Year of Development*	1997
*Validation*	Validated through various studies for reliability and effectiveness in different settings
Target Group	Infants and young children (typically 2 months to 7 years) or individuals who are non-verbal
Scoring Range	0 to 10
Components	Five categories: Face, Legs, Activity, Cry, Consolability
Scoring Method	Each category is scored from 0 to 2, with 0 indicating no pain and 2 indicating severe pain
Interpretation	0 = Relaxed and comfortable, 1-3 = Mild discomfort, 4-6 = Moderate pain, 7-10 = Severe discomfort/pain
Face	0 = No particular expression or smile, 1 = Occasional grimace or frown, 2 = Frequent to constant frown
Legs	0 = Normal position or relaxed, 1 = Uneasy, restless, tense, 2 = Kicking, or legs drawn up
Activity	0 = Lying quietly, normal position, moves easily, 1 = Squirming, shifting back and forth, 2 = Arched, rigid, or jerking
Cry	0 = No cry (awake or asleep), 1 = Moans or whimpers; occasional complaint, 2 = Crying steadily, screams or sobs, frequent complaints
Consolability	0 = Content, relaxed, 1 = Reassured by occasional touching, hugging or talking to, distractible, 2 = Difficult to console or comfort
Use in Clinical Settings	Commonly used in pediatric settings, intensive care units, and post-operative care
Advantages	Simple, quick, effective for non-verbal patients
Limitations	May not be as accurate for chronic pain assessment, relies on observer's interpretation
Training Required	Minimal; healthcare providers can quickly learn to use the scale
Revised Version	Revised-FLACC (r-FLACC) includes more detailed descriptors for each category to enhance accuracy
Application in Special Population	Adapted for use in individuals with cognitive impairments, including dementia
Comparison with Other Scales	Often compared with other pediatric pain scales like the Wong-Baker FACES Pain Rating Scale and the CHEOPS (Children's Hospital of Eastern Ontario Pain Scale)
Recommended Frequency of Use	During initial assessment, post-operative period, and regular intervals thereafter
*Accessibility*	Widely accessible and used globally in various healthcare settings

This is where the flacc scale comes in. The Flacc scale is a behavioral pain scale used to assess a person’s pain, especially those unable to communicate.

Doctors often use the flacc scale to determine the pain levels of people who can’t speak out to express the level of pain they are experiencing, and also the flacc scale is very beneficial for accessing the pain levels of infants (since they can’t talk yet).

So, the flacc scale makes healthcare/treatment much easier as it helps doctors to be able to make accurate diagnosis/prognosis for patients who are not able to communicate the levels of pain they are feeling.

So in this article, Healthsoothe is gonna expatiate on all there is to know about the flacc pain scale; what it is? Where can you get it? Who can do it? Does it have any side effects? How much does it cost? And much more.

We move.

Explaining the Flacc Scale

The FLACC scale, or Face, Legs, Activity, Cry, Consolability scale¹ is a pain assessment tool for children aged 2 months to 7 years and adults who cannot verbalize their pain².

The scale is graded from 0 to 10, with 0 denoting no discomfort. The scale comprises five criteria, each with a value of 0, 1, or 2. The flacc scale makes it easier for the doctor to understand the severity and type of pain.

Criteria for the FLACC Behavioural Pain Scale.

Behaviour	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, sobs, frequent complaints
Consolability	Content, relaxed	Reassured by touching, hugging or being talked to, distractible	Difficult to console or comfort

How to Use Flacc Scale

Two sets of instructions for the observer depend on if the patient is awake or asleep.

For awake patients:

Observe for at least 2-5 minutes
Observe the uncovered legs and body
Reposition the patient or observe activity; assess the body for tenseness and tone
If needed, initiate consoling interventions.

For asleep patients:

Observe for a minimum of 5 minutes
Observe the uncovered legs and body
Reposition the patient, if possible
Touch the body and assess the tenseness and tone

There are five categories, and each category is scored on a 0-2 scale which results in a total score of 0-10.

Interpretation of Flacc pain score - Assessment of Behavioural Score

0 → Relaxed and comfortable
1-3 → Mild discomfort
4-6 → Moderate pain
7-10 → Severe discomfort and pain

Does the Flacc Scale Have Any Side Effects?

Flacc pain scale doesn’t have any side effects as it is a non-invasive process, and rather simple to do, if you know what you are doing. And it also doesn’t take time, and many health practitioners use this method to determine a patient’s pain levels even if that person can talk or express their pain levels vocally.

Who Can Perform a Flacc Scale Test? – Can Anyone Do It?

Yes, anyone can perform a flacc scale test, provided he/she has the knowledge required to do it. It’s a non-invasive process, which can be done anywhere and anytime, and it doesn’t require much time and effort.

Where Can You Get a Flacc Scale or Undergo a Flacc Pain Scale Test?

A flacc pain scale test can be done at any professional health center like hospitals and clinics. The test can also be done at home if you have been taught well about it, or you have your doctor come over and test you.

Where Can You Buy a Flacc Scale?

Flacc scale reference cards can be bought at a hospital, a well-stocked pharmacy, and even online stores like Amazon, Walmart, and also on virtual drug stores.

How Much Does a Flacc Scale Cost?

The Flacc scale reference cards cost from $11 to $13 dollars depending on the place you are buying them from. Make sure to buy from top recommended sources.

Conclusion

The Flacc scale was originally designed and validated for use in infants and children aged 2 months to 7 years to measure postoperative pain³, but the FLACC scale has also been found to be accurate for use with adults in intensive-care units (ICU) who are unable to speak due to intubation. The FLACC scale offered the same evaluation of pain as did the Checklist of Nonverbal Pain Indicators (CNPI) scale which is used in ICUs.

All right, guys, that is it for now for flacc scale. I hope Healthsoothe answered any questions you had concerning the flacc pain scale.

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Frequently Asked Questions Related to the Flacc Scale

What Age Group is Flacc Scale Used?

The Flacc scale was originally designed and validated for use in infants and children aged 2 months to 7 years to measure postoperative pain, but the FLACC scale has also been found to be accurate for use with adults in intensive-care units (ICU) who are unable to speak due to intubation.