FLACC Scale (Face, Legs, Activity, Cry, Consolability) for Pediatric Pain
Behavioural pain assessment tool for children 2 months to 7 years (and non-verbal patients) who cannot self-report pain. Validated for post-operative and procedural pain assessment.
Score interpretation
FLACC 0 -- relaxed and comfortable; no pain indicators
→ No analgesic intervention needed; continue monitoring; reassess at regular intervals (minimum hourly post-operatively); document score; non-pharmacological comfort measures as appropriate (positioning, sucrose for neonates).
FLACC 1-3 -- mild discomfort or pain
→ Non-pharmacological measures first (positioning, distraction, parental presence, swaddling, sucrose for neonates); simple analgesia — paracetamol, or ibuprofen if 3 months or older and no contraindication — with doses from a children's formulary; reassess in 30–60 minutes.
FLACC 4-6 -- moderate pain requiring active management
→ Regular paracetamol plus ibuprofen (if 3 months or older and no contraindication); codeine is contraindicated for pain in children under 12 (MHRA 2013); consider intranasal diamorphine or oral morphine per local protocol — doses from a children's formulary; Entonox for procedures from about 4 years; reassess every 30 minutes; senior review.
FLACC 7-10 -- severe pain requiring urgent intervention
→ Urgent analgesia: IV morphine titrated to effect or intranasal fentanyl per local protocol (doses from a children's formulary) with respiratory monitoring; nurse- or patient-controlled analgesia after surgery; pain team / anaesthesia review; consider regional anaesthesia; reassess every 15 minutes; naloxone available.
Interpretation bands for the FLACC Scale. Apply clinical judgement and local guidance.
References
- Merkel SI et al. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293-297.
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.