Children need pain measures that match their age and ability to communicate. Faces scales let children from about age three point to how they feel; the FLACC lets a trained observer score pain in infants and children who cannot self-report. Both give a score from 0 to 10.
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Face
FLACCFLegs
FLACCLActivity
FLACCACry
FLACCCConsolability
FLACCOAt a glance
In trials
Paediatric analgesic and anaesthesia trials often enrol children across a wide age range, which means no single pain scale fits everyone. A common approach assigns the scale by age and ability: observational FLACC for infants, toddlers and non-verbal children, a faces scale for young children who can self-report, and a 0 to 10 numeric scale for older children. The protocol should state which scale applies to whom and how scores are combined, if at all, in the analysis.
Post-operative trials also need frequent assessments at fixed times after surgery, often by a research nurse. Recording the assessor, the time and the method with each score is what makes those data usable. See EDC for pediatric trials.
In analgesic trials, time to first rescue medication and total rescue use are often key endpoints. Record rescue doses with exact times on the same visit schedule as the pain scores.
| Assessment | Pre-op | 30 min | 1 h | 2 h | 4 h | 8 h | 24 h |
|---|---|---|---|---|---|---|---|
| FLACC (under 4 years) | |||||||
| Faces scale (4 to 7 years) | |||||||
| NRS (8 years and over) | |||||||
| Rescue medication |
Scale assigned by age and ability in the protocol
Structure
| Category | 0 | 1 | 2 |
|---|---|---|---|
| Face | Relaxed or neutral | Occasional grimace or frown | Frequent or constant frowning, jaw clenched |
| Legs | Relaxed | Restless or tense | Kicking or drawn up |
| Activity | Lying quietly, moving easily | Squirming or tense | Arched, rigid or jerking |
| Cry | None | Moaning or whimpering | Steady crying or screaming |
| Consolability | Content | Comforted by touch or talk | Hard to console |
A brief paraphrase of the FLACC categories (Merkel and colleagues, 1997). Check permission and use the official wording and scoring guidance for your study.
In Capture
Build each scale as its own section with the assessor and time recorded. Conditional logic on an age-group question shows the matching scale in the visit form, and rescue medication sits on the same schedule of frequent time points.
Window -3 / +3 days around the anchored target date
Soft window
Stays available with a protocol deviation flag
Hard window
Locks outside the window
Warning only
Stays available with a warning
Auto-close
Marked missed when the window closes
Set up FLACC and a self-report scale in the free sandbox.
Permissions
Pain scales for children are widely reproduced in clinical settings, but research and electronic use can have different terms. The Wong-Baker FACES Foundation publishes terms for research and for digital reproduction; the FPS-R is available for non-commercial use through the International Association for the Study of Pain; FLACC permissions should be checked with its developers. Record what you obtained and when.
Faces scales also depend on visual presentation. If a scale is used on screens, follow the developer's guidance on how the faces are displayed, and keep the display the same across devices so children see the same scale at every assessment.
Before go-live
FLACC, faces scale or NRS assigned in the protocol.
Terms checked for each scale and for electronic use.
FLACC scoring trained and consistent.
Fixed times relative to surgery or dosing.
Doses and times on the same schedule.
How scores from different scales are handled.
An observer scores face, legs, activity, cry and consolability from 0 to 2 each, for a total of 0 to 10.
It was developed for children aged about 2 months to 7 years, and is also used for older children who cannot self-report.
The child chooses one of six faces, scored 0, 2, 4, 6, 8 or 10.
Terms differ. The Wong-Baker FACES Foundation publishes terms for research and digital use; check permission for each scale before your study.
Many children can use a 0 to 10 numeric scale from about age 8.
Yes. Assign the scale by age and ability in the protocol and pre-specify how scores are analysed.
Keep exploring
Self-report and observational scales in one study. Free sandbox.