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 (neonates); paracetamol (oral/IV) if not contraindicated: 15 mg/kg oral 4-6 hourly (max 60 mg/kg/day, not exceeding 4 g/day); reassess in 30-60 minutes; document interventions and response; ibuprofen 5-10 mg/kg 6-8 hourly if >= 3 months and no contraindications.
FLACC 4-6 -- moderate pain requiring active management
→ Step-up analgesia: paracetamol + ibuprofen (if >= 3 months, not post-tonsillectomy per NICE) as regular scheduled doses; codeine NO longer recommended in children (FDA/EMA/MHRA withdrawal); tramadol with caution; intranasal diamorphine 0.1 mg/kg for acute moderate pain in ED; nurse-administered entonox for procedural pain (>= 4 years); oral morphine 0.1-0.2 mg/kg 4-hourly if severe/refractory; reassess every 30 minutes; senior paediatric review.
FLACC 7-10 -- severe pain requiring urgent intervention
→ Urgent analgesia: IV morphine 0.05-0.1 mg/kg slow IV bolus (max 2.5 mg per dose, may repeat at 15-30 min intervals; respiratory monitoring essential); intranasal fentanyl 1.5 mcg/kg as alternative; nurse-controlled or patient-controlled analgesia (NCA/PCA) post-operatively; pain team/anaesthesia review; consider regional anaesthesia (nerve block, epidural) for post-operative pain; reassess every 15 minutes after intervention; document all doses; monitor O2 saturation and respiratory rate; naloxone available at bedside.
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.
- NICE CG140. Pain management for sickle cell disease in children and young people. 2012.
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.