Pediatric Pain Scales on the NCLEX
FLACC, FACES, and numeric scales matched to age and development, plus neonatal tools.
Pick the wrong pain scale and every answer after it is wrong. NCLEX matches scale to developmental age, not just chronological age.
Match the scale to the child
Neonates: behavioral/physiologic tools such as CRIES or NIPS. FLACC (Face, Legs, Activity, Cry, Consolability): observational, for infants and preverbal or nonverbal children, roughly 2 months to 7 years. Each of the 5 categories scores 0-2; total 0-10. The revised FLACC extends to children with cognitive impairment. FACES (Wong-Baker): self-report using cartoon faces, from about age 3, once the child can point to the face that matches the hurt. Numeric 0-10 scale: from about age 8, when the child reliably understands number magnitude.
Rules that decide questions
Self-report is the gold standard whenever the child is developmentally able. An observational score never overrides a child who can tell you. Use the same scale consistently for one child so trends mean something, and reassess after every intervention (per your facility, commonly within 30-60 minutes). A sleeping or quiet child can still be in pain - withdrawal and stillness are pain behaviors too. Believe the parent who says the behavior is not normal for this child.
Applying it
Toddler post-op, crying, kicking, inconsolable: score with FLACC, treat, rescore. 4-year-old who can point: offer FACES; explain the faces mean hurt, not happy or sad mood. 10-year-old: numeric scale, plus location and quality in their own words. Nonverbal 9-year-old with cerebral palsy: revised FLACC with the parents' input on baseline behaviors. Pair every score with age-appropriate comfort: swaddling and sucrose for neonates, distraction and comfort positioning for toddlers, preparation and choices for school age.
Frequently asked
Child says 2 but grimaces and guards?
Explore further, but self-report stands as the primary measure when the child is developmentally able. Reassess, involve parents, and consider fear or misunderstanding of the scale.
Which scale for a 5-year-old?
FACES. Old enough for self-report, usually too young for a reliable 0-10 number.
Can you use FLACC on a sedated ICU kid?
Observational tools fit nonverbal patients, and FLACC variants are used, though critical-care units often have dedicated tools. Follow facility policy.
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