FLACC scale

The FLACC scale or Face, Legs, Activity, Cry, and Consolability scale is one of the most commonly and widely used behavioral observation pain scales to assess pain for children between the ages of 2 months and 7 years or individuals that are unable to communicate their pain. The level of response for each observation is given a numerical value rating from “0” to “2,” with “0” being the most comfortable with no pain and “2” being the most painful, which results in a total score between “0” and “10.”

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 scale which is used in ICUs ¹.

Table 1. FLACC pain scale

Criteria	Score 0	Score 1	Score 2
Face	No particular expression or smile	Occasional grimace or frown, withdrawn, uninterested	Frequent to constant quivering chin, clenched jaw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 or sobs, frequent complaints
Consolability	Content, relaxed	Reassured by occasional touching, hugging or being talked to, distractible	Difficult to console or comfort

Instructions

• Patients who are awake:
  • Observe for at least 2-5 minutes.
  • Observe legs and body uncovered.
  • Reposition patient or observe activity; assess body for tenseness and tone.
  • Initiate consoling interventions if needed.
• Patients who are asleep:
  • Observe for at least 5 minutes or longer.
  • Observe body and legs uncovered.
  • If possible reposition the patient.
  • Touch the body and assess for tenseness and tone.

Each category is scored on the 0-2 scale which results in a total score of 0-10.

Assessment of FLACC Pain Score:

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

References

1. Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S (2010). “Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients”. Am. J. Crit. Care. 19 (1): 55–61. doi:10.4037/ajcc2010624