The Face, Legs, Activity, Cry, and Consolability (FLACC) scale
Original Editor - Trista Chan
Top Contributors - Trista Chan
Objective[edit | edit source]
The Face, Legs, Activity, Cry and Consolability (FLACC) scale is an observational pain scale. It is widely used in the paediatric population to assess pain in infants and children who are unable to verbally express their pain. [1]Instead, the FLACC scale is developed to help understand their pain experience by observing facial experessions and behavioural patterns, to enable the provision of effective pain intervention. [2]
Intended Population[edit | edit source]
The FLACC scale is primarily designed for measuring postoperative pain in infants and children from 2 months to 7 years. [1] Specifically, it targets those who have difficulty in verbalising pain due to developmental, cognitive or communication barriers. [3]
Method of Use[edit | edit source]
The FLACC scale includes five sections (i.e., face, legs, activity, cry and consolability) of signs and behaviors which indicate distress. The total score for FLACC scale ranges from 0-12, with each category is scored on a scale of 0-2, as shown below. [4]
| Categories | scoring | ||
|---|---|---|---|
| 0 | 1 | 2 | |
| Face | No distinct facial expression or smile. | Intermittently showing grimaces or frowns or showing withdrawal or indifference. | Frequently or constantly quivering their chin or clenching their jaws. |
| Legs | Normal or relaxed state. | Showing signs of agitation, restlessness or tension. | Kicking or drawing their legs up. |
| Activity | Quietly lying in a normal position and moves effortlessly. | Fidgeting, moving back and forth and showing tension. | Arched or stiff posture or jerking movements. |
| Cry | Not crying. | Moaning, whimpering or complaining from time to time. | Contantly crying, screaming, sobbing or complaining. |
| Consolability | Relaxed and at ease. | Can be distracted or reassured by physical comfort (e.g. touching and hugging) or with conversation. | Hard to consol or comfort. |
Evidence[edit | edit source]
Studies have pointed out that there is insufficient evidence to support the use of FLACC scale for evaluating children's pain, particularly whether the FLACC scale should be used to measure pain beyond what is originally designed for (i.e., postoperative pain). In addition, further studies are needed to overcome the methodological limitations in the previous studies.[1]
Reliability:[edit | edit source]
The inter-rater reliability for FLACC scale when used during painful procedures, ranges from 0.85-0.99 in several studies. However, it is importatnt to note the differng results during painful phase and baseline phase.
The intra-rater reliability in several studies range from 0.88-098. Yet, the studies included children from different age groups, therefore, it is inconclusive whether the results of these studies are sufficiently reliable.
Validity:[edit | edit source]
A few studies found some correlation between FLACC scale and self-reported pain scales, with correlation ranging from fair to high (r =0.3-0.8). However, in another study, the correlation of FLACC scale and objective pain scale in younger children is less significant (r=0.254, P=0.381). Some studies have also pointed out that the descriptors in the FLACC scale may be inconsistent with observation.
Responsiveness:[edit | edit source]
Some studies found high correlations of FLACC scale and several other behavioural rating scale (r=0.88-0.94). Yet, it is also stated that responsiveness of the FLACC scale may be affected by fear and anxiety as response to these emotions potentially imitate pain response. For example, a study have found moderate correlations (r=0.63) between FLACC scale and anxiety scale.
References[edit | edit source]
- ↑ 1.0 1.1 1.2 Crellin DJ, Harrison D, Santamaria N, Babl FE. Systematic review of the Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children. PAIN. 2015 Nov;156(11):2132–51.
- ↑ voepel-Lewis T, Merkel S, Tait AR, Trzcinka A, Malviya S. The Reliability and Validity of the Face, Legs, Activity, Cry, Consolability Observational Tool as a Measure of Pain in Children with Cognitive Impairment. Anesthesia & Analgesia. 2002 Nov;95(5):1224–9.
- ↑ Willis MHW, Merkel S, Voepel-Lewis T, Shobha Malviya. FLACC Behavioral Pain Assessment Scale: a comparison with the child’s self-report. 2003 Jul 3;29(3):195–8.
- ↑ Chan AY, Ge M, Harrop E, Johnson M, Oulton K, Skene SS, et al. Pain assessment tools in paediatric palliative care: A systematic review of psychometric properties and recommendations for clinical practice. Palliative Medicine. 2021 Dec 29;36(1):30–43.
- ↑ Dafna Munitz‐Shenkar, Kreitler MM, Kreitler S. Appendix A: Assessment Tools in Pediatric Psycho-Oncology. 2012 Jul 1;269–97.
