Instructions

1 Write a 0 if Itie behavior was not observed

2. Write a 1 if Une behavior even briefly during activity or rest

3. Results in a total score between 0 and 5.

4. The interdisciplinary team in collaboration with the patient (if appropriate), can determine appropriate interventions in response to CNVI scores

Figure 17.3 Non-verbal indicators. National Institutes of Health, Warren Grant Magnuson Clinical Center. Pain Intensity Instruments, July 2003.

Table 17.1 Face, Legs, Activity, Cry, Consolability (FLACC) Scale.

Category

Scoring

1

2

3

Face

No particular expression or

Occasional grimace or frown, withdrawn,

Frequent to constant

smile

disinterested

quivering chin, clenched jaw

Legs

Normal position or relaxed

Uneasy, restless, tense

Kicking or legs drawn up

Activity

Lying quietly, normal

Squirming, shifting back and forth, tense

Arched, rigid, or jerking

position, moves easily

Cry

No cry (awake or asleep)

Moans or whispers, occasional complaint

Crying steadily, screams, or

sobs, frequent complaints

Consolability

Content, relaxed

Reassured by occasional touching, hugging, or

Difficult to console or

being talk to, distractable

comfort

Each of the five categories (F) Face, (L) Legs, (A) Activity, (C) Cry, (C) Consolability is scored from 0 to 2, which results in a total score between 0 and 10. Adapted from Merkel et al. (1997).

Each of the five categories (F) Face, (L) Legs, (A) Activity, (C) Cry, (C) Consolability is scored from 0 to 2, which results in a total score between 0 and 10. Adapted from Merkel et al. (1997).

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