Pain Assessment

FLACC Pain Tool

The Face, Legs, Activity, Cry, and Consolability (FLACC) tool was originally designed to assess pain in nonverbal (young) children, based on observations of behaviours (Merkel et al., 1997). As suggested by its name, the tool includes five categories:

  • Face.
  • Legs.
  • Activity.
  • Cry.
  • Consolability.

The maximum total score is 10, with scores for each category ranging from 0 to 2 (Merkel et al., 1997). This is helpful, because the FLACC findings can be easily compared to those of other common pain rating systems that are rated out of 10, such as the NRS (Voepel-Lewis et al., 2010).

The FLACC tool can be used with children as young as 2 months of age or any child who is too distressed or sedated to accurately self-report (Freund & Bolick, 2019). It has demonstrated good psychometric testing (Voepel-Lewis, 2010) and has been translated into several languages including French and Chinese, so it can be used across many client populations (Voepel-Lewis, 2010. It has also been used in practice with non-verbal adults with cognitive impairment and critically ill adults (Voepel-Lewis, 2010).

A revised FLACC pain assessment tool is also available, with additional behavioural descriptors for clients with cognitive impairment (Malviya et al., 2005). To compare the FLACC and the revised FLACC, check out the table at this link:

Clinical Tip

Like all behavioural tools, the FLACC cannot distinguish between pain and other forms of distress (Parker & Brown, 2019). Think critically when interpreting behaviours that may be pain-related and when making treatment decisions based on the FLACC total score. You should observe the client for at least 2–5 minutes before assigning a score (Parker et al., 2019).


Freund, D., & Bolick, B. (2019). Assessing a child’s pain. The American Journal of Nursing, 119(5), 34-41.

Malviya, S., Voepel-Lewis, T., Burke, C., Merkel, S., Tait, A. (2005). The revised FLACC observational pain tool: Improved reliability and validity for pain assessment in children with cognitive impairment. Pediatric Anesthesia, 16(3), 258-265.

Merkel, S., Voepel-Lewis, T., Shayevitz, J., & Malviya, S. (1997). The FLACC: A behavioural scale for scoring postoperative pain in young children. Pediatric Nursing, 23(3), 293-297.

Parker, M., & Brown, N. (2019). Pre-hospital pain assessment in paediatric patients. Emergency Nurse, 27(2), 16-20.

Voepel-Lewis, T., Zanotti, J., Dammeyer, J., & Merkel, S. (2010). Reliability and validity of the Face, Legs, Activity, Cry, Consolability Behavioral Tool in assessing acute pain in critically ill patients. American Journal of Critical Care, 19(1), 55-61.



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