Faces Pain Scale
Introduction[edit | edit source]
The Faces Pain Scale is a self-report measure used to assess the intensity of children's pain. It is generally accepted that the measurement of pain in children, by healthcare professionals, is a difficult task. This is due to the children's varying levels of language, communication, and development, and the way in which they express pain, compared to an adult.  One way of measuring pain in Children is by using scales of various facial expressions, and associating their pain level to a similar face.
Once faces pain scale commonly preferred by children and parents for reporting pain severity is the Wong-Baker Faces Pain Scale. 
- This type of scale uses a series of facial expression illustrations to outline a scale of pain severity. 
- It is noted that children prefer the design of faces presented on the Wong-Baker Faces Pain Scale. 
- The use of a 'faces scale' should not need to incorporate the intervention of an adult explaining the scale, the faces, or how to interpret the pictures. 
- Measuring the rating of pain with a Faces scale is an ordinal outcome measure, which has a minimal and set number of categorical responses which are presented in a given pattern. 
Audience[edit | edit source]
The Wong-Baker Faces Pain Scale can be confidently used by children as young as 3 years old. It is assumed that children at this age should be able to distinguish fascial expressions related to pain, and identify the severity. 
The purpose of this scale is to impose a reduced cognitive burden on children, and thus it is designed for very young children. It is assumed that children are capable of recognizing facial expressions rather than verbal or numerical ratings (as on other pain scales). It is noted that by the age of 4 and 5, children have the capability to identify and distinguish various facial features and facial patterns of different general emotions. 
It is noted that young infants are able to adjust their fascial expression to address various signs of pain. With development, the infants/children are able to recognize anger reactions. Various emotions become learned and expressed throughout adulthood. 
Scoring[edit | edit source]
A 0 point 'happy face' represents the absence or lack of pain. 
A 10 point 'crying face' represents the worst possible or most excruciating pain. 
All the faces in between represent a scoring of 2, 4, 6, or 8, respectively, based on the pain severity facial image chosen. 
The child is instructed to point to the face that best represents the severity of pain that they are experiencing.   Their response is associated with the number allocated to the chosen face. 
Benefits[edit | edit source]
The Wong-Baker Faces Pain Scale is easy and quick to use. It is a nonverbal assessment, with minimal instructions required. It can be administered by a health care professional, parent, or an older child. 
Implications/Limitations[edit | edit source]
Wen used on children in the Emergency Department at the Hospital, the most common selected Face was the 'hurts even more', which is associated with a Visual Analog Scale (VAS) score of 55. One-fifth of a study population of children in the emergency department reported a VAS score of 80. However, many of these children did not select the 'worst hurt' face. It is seen that identifying the faces on the Wong-Baker Faces Pain Scale are emotionally driven, which may be misidentified as non-painful emotions, and thus may skew severity reporting. 
Another study found that the inclusion of a smiling face drove pain ratings away from the 'no pain' end of the spectrum. 
It was seen that children under 10 years old were unable to properly identify the feelings of pain, anxiety, and emotions. Pre-operative children were seen to select faces other than the smiling face. Sometimes after surgery, such as abdominal surgery, children were seen to choose the smiling face. Thus it is seen that children's interpretation for pain may be indicating fear, which is not the intention of the Wong-Baker Faces Pain Scale. 
A study comparing the Wong-Baker Faces Pain Scale and the Wong-Baker Faces Pain Scale - Revised, with parents administering the scale, found that parents did not have a correct interpretation of the children's pain indication, and should not be used as a replacement for children's self-report of pain perception. It is seen that healthcare professionals generally have a poor interpretation of children's pain, and is questioned whether it is the same case for the children's parents. 
It is reported that caregivers have a poor perception their children's pain from ages 3-7.5 years old, using the Faces Pain Scale. 
Children's understanding of the Faces Pain Scale[edit | edit source]
It is seen that children aged 6 and 8 years old were able to identify facial expression by analysis of the eyes and mouth. They were seem to have a clear understanding of pain, and how to identify different levels or types of pain. 
Validity[edit | edit source]
The Faces Pain Scale shows reliability and consistency when pain ratings are assigned by children, especially as they are associated with related pain experiences. It is a scale that can be reliably and validly used in young children, with minimal cognitive demands. 
The Wong-Baker pain scale has been validated outside the Emergency Department as a measure of chronic pain. 
Furthermore, when compared to the Visual Analogue Scale (VAS), the Wong-Baker Faces Pain Scale produced analogous and equivalent results. 
Resources[edit | edit source]
- Here is a PDF of the Wong-Baker Faces Pain Scale, with instructions.
- Here is a PDF of the Wong-Baker Faces Pain Scale, without instructions.
- Here is the Wong-Baker FACES Foundation Website, which provides information and facts about the Wong-Baker Faces Pain and about the Association, with links to some podcasts.
References[edit | edit source]
- Bieri Daiva, Reeve Robert A, Champion G. David, Addicoat Louise, Ziegler John B. The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: development, initial Validation, and preliminary investigation for ratio scale properties. Pain. 1990:41:139-150.
- Garra Gregory, Singer Adam J, Domingo Anna, Thode Henry C. The Wong-Baker Pain FACES Scale Measures Pain, Not Fear. Pediatric Emergency Care. 2013:29(1):17-20.
- Garra Gergory, Singer Adam J, Taira Breena R, Chohan Jasmin, Cardoz Hiran, Chisena Ernest, Thode Henry C. Validation of the Wong-Baker FACES Pain Rating Scale in Pediatric Emergency Department Patients. Academic Emergency Medicine. 2010:17(1):50-54.
- Zielinski Jakub, Morawska-Kochman Monika, Zatonski Tomasz. Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children. Advances in Clinical and Experimental Medicine. 2020:29(3):1-10.
- Lawson Simone L, Hogg Melanie M, Moore Charity G, Anderson William E, Osipoff Paul S, Runyon Michael S, Reynolds Stacy L. Pediatric Pain Assessment in the Emergency Department: Patient and Caregiver Agreement Using the Wong-Baker FACES and the Faces Pain Scale–Revised. Pediatric Emergency Care. 2021:37(12):e950-e954.