FLACC Behavioral Pain Assessment Scale: A Comparison With the Child's Self-Report

Martha H. W. Willis, Sandra I. Merkel, Terri Voepel-Lewis, Shobha Malviya


Pediatr Nurs. 2003;29(3) 

In This Article

Abstract and Introduction


The purpose of this study was to further test the validity of the Faces, Legs, Activity, Cry and Consolability (FLACC) Behavioral Pain Assessment Scale for use with children. Thirty children aged 3-7 years (5.01 ± 1.44) who had undergone a variety of surgical procedures were observed and assessed for pain intensity at 20 + 2 hours after surgery. FLACC scores were assigned by one of the nurse investigators, and a self-report of pain using the FACES scale was obtained from the child. There were significant and positive correlations between the FLACC and FACES scores for the entire sample and for the scores of children 5-7 years of age, but not for children < age 5. These findings provide additional support for the construct validity of the FLACC Pain Assessment Tool.


The difficulty quantifying and qualifying pain in young children may place this population at risk for inadequate pain control (Colwell, Clark, & Perkins, 1996). While self-report of pain should be obtained whenever possible, behavioral observation remains the primary method for pain assessment in children with limited verbal and cognitive skills. The Faces, Legs, Activity, Cry and Consolability (FLACC) Behavioral Pain Assessment Tool (see Table 1 ) was developed to provide a simple and consistent method for nurses to identify, document, and evaluate pain in children who have difficulty verbalizing the presence or intensity of pain (Merkel, Voepel-Lewis, Shayevitz, & Malviya, 1997). This study was designed to further validate the FLACC tool by comparing nurse assigned FLACC scores to the child's self-report of pain.


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