Paediatric postoperative pain

The FLACC scale is a commonly used tool for assessing pain in a population who may not be able to verbalise postoperative pain or discomfort. Which one of the following statements is CORRECT?

a) The tool is applicable to the age range: two months to seven years

b) The ‘A’ in FLACC stands for ‘Arms’

c) The maximum score, indicating the worst possible pain, is 15

d) A child who is kicking with their legs drawn up would score 1 for legs

e) The nature of the child’s crying has no impact on the score

Answer: a

Explanation

The tool scores from zero to two points each for five parameters: face, legs, activity, cry

and consolability. The sum of these gives the final score – a score of ten being the

maximum, indicating the worst pain. As described, the tool is validated for children

between two months and seven years of age. The scale has not been validated for

children with developmental delay. This is a behavioural tool as opposed to one that

relies upon patient participation. A child who is kicking and drawing their legs up

scores a maximum 2 points for legs. With respect to the nature of crying: moans or

whimpers score 1, whereas steady screaming scores 2. In the literature the tool has been

compared with other paediatric behavioural pain assessment tools: CHEOPS

(Children’s Hospital of Eastern Ontario pain scale), OPS (Objective pain scale),

TPPPS (Toddler-pre-school postoperative pain scale). The Wong & Baker FACES

scale and visual analogue scales are patient-reporting tools.

Reference

Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for

scoring postoperative pain in young children. Pedatr Nurs 1997; 23(3): 293–7.