FLACC
Non-Verbal Pain Assessment
Five behaviors × 0/1/2 = 0-10 pain score for patients who can't self-report.
For the FNP boards, FLACC is the assessment tool for any patient who cannot self-report pain — preverbal infants, intubated adults, advanced dementia. Five behaviors scored 0, 1, or 2 each: Face (no expression to constant grimace), Legs (relaxed to kicking), Activity (lying quietly to thrashing), Cry (no cry to constant), Consolability (content to inconsolable). Total runs 0-10 to map onto the standard pain scale. AANP exam vignettes use FLACC to test whether you assess pain in nonverbal patients at all — a frequent failure point in the literature — and whether you treat based on observed score rather than waiting for a verbal report that will not come.
- FFaceRelaxed (0) / Grimace (1) / Clenched jaw (2).
- LLegsRelaxed (0) / Restless (1) / Kicking (2).
- AActivityQuiet (0) / Squirming (1) / Rigid / arched (2).
- CCryNone (0) / Moaning (1) / Steady cry or scream (2).
- CConsolabilityContent (0) / Distracted by touch (1) / Inconsolable (2).
Clinical Context
Pain scale for patients who can't self-report — children 2 months to 7 years, and nonverbal adults (dementia, developmental delay, intubated). Each behavior scores 0-2 for a total 0-10, corresponding to the standard 0-10 self-report pain scale.
Reassess after every intervention. Remember: a crying infant isn't always in pain — hunger, tiredness, wet diaper, and overstimulation mimic. Use clinical judgment alongside the FLACC score. AANP pediatric and geriatric pain-assessment questions rely on this scale.
Practice Questions
A 3-year-old boy presents to the pediatric clinic the day after a minor outpatient procedure. The nurse practitioner observes: facial grimacing with a clenched jaw, legs drawn up and kicking, body arched and rigid, steady crying, and the child remains inconsolable despite his mother's attempts to comfort him. Using the FLACC scale, what is this child's pain score?
Related Mnemonics
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