Which pain scale is validated for nonverbal infants and young children?

• A. FLACC scale
• B. Wong-Baker FACES Pain Rating Scale
• C. Numeric Rating Scale 0-10
• D. Visual Analog Scale

Answer: (A)

Nonverbal infants and young children can’t tell you how much pain they’re in, so you rely on observable behaviors to assess it. The FLACC scale does this with five domains—face, legs, activity, cry, and consolability—and assigns 0 to 2 for each, totaling 0 to 10. It’s validated for children from about 2 months up to 7 years and is specifically tailored for those who cannot verbalize their pain, providing a reliable, behavior-based measure that can guide analgesia and track changes over time.

Scales that require the child to express pain or map it to numbers or faces aren’t appropriate for this group. The Wong-Baker FACES scale depends on the child identifying a facial expression that matches their pain level, which isn’t feasible for very young or nonverbal children. Numeric Rating and Visual Analog scales require self-report and understanding of numbers or a continuum, which nonverbal infants and toddlers can’t provide reliably.