Reference — Pediatrics
Pediatric Pain Scales Reference
A child’s pain is only as accurate as the tool you choose for their developmental age. Self-report when they can, behavioral observation when they can’t — and the cutoff is roughly the ability to understand numbers.
Educational use only. Pain tool selection and reassessment timing follow your facility’s policy. Always pair the score with the clinical picture and treat pain per provider orders. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Pick the Tool by Age
| Scale | Best for | How it works |
|---|---|---|
| NIPS / CRIES | Neonates (preterm–early infancy) | Behavioral + physiologic scoring (facial expression, cry, breathing, arms/legs, arousal; CRIES adds vitals and oxygen need) |
| FLACC | 2 months – ~7 years, or any nonverbal/cognitively impaired child | Observe 5 behaviors — Face, Legs, Activity, Cry, Consolability — each scored 0–2 for a total of 0–10 |
| Wong-Baker FACES / FACES Pain Scale–Revised | ~3 years and up | Child points to the face that matches their hurt; faces map to 0–10 |
| Numeric Rating Scale (0–10) | ~7–8 years and up | Child rates pain 0 (none) to 10 (worst); requires numeric understanding |
FLACC — The Behavioral Standard
| Category | 0 | 1 | 2 |
|---|---|---|---|
| Face | No expression/smile | Occasional grimace, frown, withdrawn | Frequent/constant frown, clenched jaw, quivering chin |
| Legs | Relaxed | Uneasy, restless, tense | Kicking or legs drawn up |
| Activity | Lying quietly, moves easily | Squirming, shifting, tense | Arched, rigid, or jerking |
| Cry | No cry (awake or asleep) | Moans, whimpers, occasional complaint | Steady cry, screams, frequent complaints |
| Consolability | Content, relaxed | Reassured by touching/talking, distractible | Difficult to console or comfort |
Total 0–10: 0 relaxed/comfortable · 1–3 mild discomfort · 4–6 moderate pain · 7–10 severe pain.
Using the Scales Well
Self-report beats observation whenever the child can do it — believe the child’s number even if they don’t “look” in pain.
Wong-Baker FACES rates how the child FEELS inside, not which face the child’s own expression matches — teach it that way, and don’t anchor it to tears (the smiling-face end is “no hurt,” not “happy”).
Use the same scale each time for a given child so scores are comparable, and reassess after interventions at the expected peak effect of the medication or measure.
Incorporate the parent’s read — caregivers often detect subtle behavior change first — and remember chronic pain and cognitive impairment may blunt the expected behaviors (FLACC has validated adaptations).
NCLEX Pearls
- ✦FLACC (Face, Legs, Activity, Cry, Consolability) is the go-to for infants and any nonverbal child; each item scores 0–2 for a 0–10 total.
- ✦Wong-Baker FACES works from about age 3; the numeric 0–10 scale needs roughly age 7–8 and numeric understanding.
- ✦When a child can self-report, the self-report is the most accurate measure — use it over behavioral scoring.
- ✦Neonates get NIPS or CRIES — behavioral plus physiologic, because they can't show pain the usual ways.
- ✦Pick one scale per child and reuse it so trends mean something.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · CDC / ACIP (immunization schedule). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →