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FLACC Pain Score

25 Feb 2024

Tags: Paediatric Examinations | Paediatrics


When children experience pain, especially those who are too young to articulate their discomfort, it can be challenging to assess their level of distress accurately. The FLACC pain score offers a practical solution and is developed specifically for paediatric patients which provides a structured method for evaluating pain based on observable behaviours.

What Is The FLACC Pain Score?

FLACC stands for Face, Legs, Activity, Cry, and Consolability. It is a behavioural assessment tool designed to evaluate pain in infants and young children who may not be able to communicate their discomfort verbally. The scale assigns a score to each of these five categories, with higher scores indicating more significant pain.

How To Use The FLACC Pain Score?

For awake patients:

Monitor for a duration of 1 to 5 minutes or more. Ensure the legs and body are exposed for observation. Adjust the patient’s position or monitor their activity. Evaluate the body for any signs of tension or stiffness. Intervene with comforting measures if necessary.

For sleeping patients:

Observe for 5 minutes or longer. Keep the body and legs uncovered for better observation. If feasible, reposition the patient. Assess the body’s stiffness and tone through gentle touch.

FLACC Components

Face: Assess the child’s facial expressions for signs of pain, such as grimacing, furrowing of the brow, or clenched jaw.

Legs: Observe the child’s leg movements or body positioning. Signs of pain may include kicking, tensing of muscles, or reluctance to move.

Activity: Evaluate the child’s overall activity level. Restlessness, agitation, or inability to engage in typical activities may indicate pain.

Cry: Listen for vocalizations that suggest distress, such as crying, moaning, or whimpering.

Consolability: Determine how easily the child can be comforted or consoled. Difficulty in soothing the child despite efforts may indicate significant pain.


FLACC pain scoring ranges from 0 to 2 for each component.


Score 0 if the patient has a relaxed face, makes eye contact, shows interest in surroundings.

Score 1 if the patient has a worried facial expression, with eyebrows lowered, eyes partially closed, cheeks raised, mouth pursed.

Score 2 if the patient has deep furrows in the forehead, closed eyes, an open mouth, deep lines around nose and lips.


Score 0 if the muscle tone and motion in the limbs are normal.

Score 1 if patient has increased tone, rigidity, or tension; if there is intermittent flexion or extension of the limbs.

Score 2 if patient has hypertonicity, the legs are pulled tight, there is exaggerated flexion or extension of the limbs, tremors.


Score 0 if the patient moves easily and freely, normal activity or restrictions.

Score 1 if the patient shifts positions, appears hesitant to move, demonstrates guarding, a tense torso, pressure on a body part.

Score 2 if the patient is in a fixed position, rocking; demonstrates side-to-side head movement or rubbing of a body part.


Score 0 if the patient has no cry or moan, awake or asleep.

Score 1 if the patient has occasional moans, cries, whimpers, sighs.

Score 2 if the patient has frequent or continuous moans, cries, grunts.


Score 0 if the patient is calm and does not require consoling.

Score 1 if the patient responds to comfort by touching or talking in 30 seconds to 1 minute.

Score 2 if the patient requires constant comforting or is inconsolable.

FLACC Pain Score


When possible, it’s advisable to combine behavioral pain assessment with self-reporting. In situations where self-reporting isn’t an option, understanding pain behaviors and making treatment decisions necessitate thorough consideration of the circumstances surrounding the observed pain behaviors.

Each category is graded on a scale from 0 to 2, yielding a cumulative score ranging from 0 to 10.

A score of 0 indicates the individual is relaxed and at ease.

Scores between 1 and 3 suggest mild discomfort.

Moderate pain falls within the range of 4 to 6.

A score of 7 to 10 signifies severe discomfort or pain, or a combination of both.


The incorporation of behavioural measurement alongside self-reporting is highly recommended whenever feasible for assessing pain. However, when individuals are unable to self-report, the use of the FLACC pain score becomes crucial in guiding treatment decisions.

Key Points

  • Using self-reporting and behavioural observation together offers a fuller understanding of pain.
  • The standardised 0-10 FLACC scale ensures precise pain measurement and communication.
  • Tailoring treatment based on individual needs optimises pain management and enhances patient well-being.


Thomas, E. (2019). FLACC Pain Scale Infographic – Cerebra. Https://Cerebra.org.uk/. https://cerebra.org.uk/download/flacc-pain-scale-infographic/