What Is the FLACC Scale?

Dan Harkins

Physicians, physical therapists and chiropractors regularly use pain scales to determine how much a patient is suffering, and then alter treatment plans to manage symptoms most effectively. A few of these charts are specifically geared toward young children and other people who are unable to fully articulate their levels of discomfort. The Face, Legs, Activity, Cry and Consolability (FLACC) Scale is used when even the iconic faces-based pain scale is too advanced for the patient. For each segment of this consolation scale, the clinician assigns the patient a score of zero, one or two. The sum of each section is the patient's pain score, from zero at pain-free to 10 at excruciating.

A chiropractor may use the FLACC scale to help determine the pain level of a client.
A chiropractor may use the FLACC scale to help determine the pain level of a client.

The FLACC scale is specific and observational, not requiring any interaction with a young or otherwise uncommunicative patient. Each of the five categories has three easy-to-characterize rankings into which to lump the patient. All of the categories are specific to the particular part of the patient's condition being gauged.

In the Face category of the FLACC scale, the doctor gives the patient a zero if he or she is smiling or not exhibiting any strain. A one is given for irregular frowning or a detached demeanor, and a three is given if the jaw is clenched or the chin is quivering. Similarly for the Legs, zero is for a relaxed stance, one is for tenseness or restlessness, and two is for the legs constantly kicking or tensed to the chest.

The remainder of the categories follow along this same path. For Activity, the FLACC scale ranges from a calm demeanor to rigidity. The Cry section goes from asleep or no crying to constant wailing. Finally, the Consolability component refers to how much the patient's pain is relieved by parental comfort, from easily relieved to utterly inconsolable.

If children are verbal and have mastered expressing basic feelings like sadness, joy and discomfort, a clinician is apt to ashew the FLACC scale in favor of the Wong-Baker Faces pain chart found in examination rooms throughout the world. This chart, which does not even require a shared language between doctor and patient, rates pain with six faces, presented in order from happy to weeping. Underneath the faces is a number scale from "no hurt" at zero to "hurts the worst" at 10.

Aside from the FLACC, faces and numeric scales, the National Institutes of Health's Pain Consortium considers a few other tests to be useful for determining the pain levels of patients. A CRIES test is particularly useful. This test rates the "Cry," the patient's "Requirement" for supplemental oxygen, whether vital signs have "Increased," the "Expression" on the patient's face, and how "Sleepless" the patient has been.

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