Faces Pain Scale

Original Editor - Kapil Narale


Top Contributors - Kapil Narale and Lucinda hampton  

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Introduction - what it is, what it measures[edit | edit source]

It is a generally accepted fact that the measurement of pain in Children, by Healthcare Professionals, is a very difficult task. This is because of children's varying levels of language, communication, and development, and the way in which they express pain, compared to an adult. [1] 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 such scale commonly preferred by children and parents for reporting pain severity is the Wong-Baker Faces Pain Scale. [2]


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. [1]

Audience[edit | edit source]

The Wong-Baker Faces Pain Scale is designed for (age group) ...

It is assumed that children as young as 4 years old should be able to distinguish fascial expressions related to pain, and identify the severity. [1]

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 fesatues and fascial patterns of different general emotions. [1]

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. [1]

Scoring[edit | edit source]

Benefits[edit | edit source]

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. [2]

Another study found that the inclusion of a smiling face drove pain ratings away from the 'no pain' end of the spectrum. [2]

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 ndicatinf ear, which is not the intention of the Wong-Baker Faces Pain Scale. [2]

Children's understanding of the Faces Pain Scale[edit | edit source]

Validity[edit | edit source]

Resources[edit | edit source]

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References[edit | edit source]

  1. 1.0 1.1 1.2 1.3 1.4 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.
  2. 2.0 2.1 2.2 2.3 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.