Behavioural Observational Pain Scale (BOPS) for Post-Operative Paediatric Pain
Three-item observational pain scale for post-operative pain assessment in children aged 1-7 years. Validated in children unable to self-report pain. Uses facial expression, verbalisation, and body position.
Score interpretation
BOPS 0-2 -- no significant pain or mild discomfort
→ Continue post-operative monitoring; reassess BOPS every 1-2 hours; non-pharmacological comfort measures; scheduled paracetamol if appropriate; document score.
BOPS 3-4 -- moderate pain; analgesic administration indicated
→ Administer prescribed analgesic: paracetamol 15 mg/kg oral/IV 4-6 hourly; ibuprofen 5-10 mg/kg 6-8 hourly (>= 3 months, not post-tonsillectomy per NICE advice); reassess BOPS in 30-60 minutes; document intervention and response; escalate if no improvement.
BOPS 5-6 -- severe pain; immediate analgesic intervention required
→ Immediate analgesia: IV morphine 0.05-0.1 mg/kg slow IV (max 2.5 mg), may repeat at 15-30 min with SpO2 and RR monitoring; or intranasal fentanyl 1.5 mcg/kg; ensure regular background analgesia (paracetamol + NSAID); pain team review if IV opioid needed > 2 doses post-operatively; anaesthetist review; reassess every 15 minutes; document all doses administered.
Interpretation bands for the BOPS. Apply clinical judgement and local guidance.
References
- Bhatt M et al. Reliability and validity of the behavioral observational pain scale (BOPS) for post-operative pain assessment in children 1-7 years. Paediatr Anaesth. 2006;16(2):111-116.
- SIGN 116. Acute pain management. Scottish Intercollegiate Guidelines Network. 2019.
Related
Curated clinical cross-links plus same-class fallbacks.
- Numeric Rating Scale (NRS) for Pain · Pain Assessment
- Critical-Care Pain Observation Tool (CPOT) · Pain Assessment
- Behavioral Pain Scale (BPS) for Ventilated Patients · Pain Assessment
- Pain Assessment in Advanced Dementia Scale (PAINAD) · Pain Assessment
- Abbey Pain Scale for Dementia · Pain Assessment
- DN4 Questionnaire for Neuropathic Pain · Pain Assessment
- Oxycodone (Orthopaedic Post-operative Pain) · Opioid Analgesic — Strong
- Paracetamol (Paediatric) · Analgesic / Antipyretic — First-Line Pain and Fever in Children
- Morphine (Paediatric) · Opioid Analgesic — Moderate to Severe Pain in Children
- Morphine (PCA — Post-Operative Pain) · Opioid Analgesic — Patient-Controlled Analgesia
- Tramadol (Post-Operative Pain) · Weak Opioid / Serotonin-Noradrenaline Reuptake Inhibitor (Analgesic)
- Morphine · Opioid Analgesic — Severe Ureteric Colic / Post-Operative Pain
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.