Page 273 Guide to Pain Management in Low-Resource Settings

Pain Management in Children 261

Neonatal/Infant Pain Scale (NIPS)
Pain Assessment Score
Facial Expression
0—Relaxed muscles Restful face, neutral expression.
1. Grimace Tight facial muscles, furrowed brow/chin/jaw (negative facial expression—
nose, mouth, and brow).
Cry
0. No Cry Quiet, not crying.
1. Whimper Mild moaning, intermittent.
2. Vigorous Cry Loud scream; rising, shrill, continuous (note: silent cry may be scored if
baby is intubated, as evidenced by obvious mouth and facial movements).
Breathing Patterns
0. Relaxed Usual pattern for this infant.
1. Change in Breathing Indrawing, irregular, faster than usual; gagging; breath holding.
Arms
0. Relaxed/Restrained No muscular rigidity; occasional random movements of arms.
1. Flexed/Extended Tense, straight arms; rigid and/or rapid extension/fl exion.
Legs
0. Relaxed/Restrained No muscular rigidity; occasional random movements of legs.
1. Flexed/Extended Tense, straight legs; rigid and/or rapid extension/fl exion.
State of Arousal
0. Sleeping/Awake Quiet, peaceful sleeping or alert.
1. Fussy Alert, restless and thrashing.
Fig. 5. Neonatal/Infant Pain Scale (NIPS). An example of an evaluated pain rating scale for neonates and in-
fants. Th e maximum score is 6; a score greater than 3 indicates pain. (From: Lawrence J, et al. Th e development
of a tool to assess neonatal pain. Neonatal Nets 1993;12:59–66.)

Pain Assessment Score
Facial Expression
0– No particular expression or smile.
1– Occasional grimace or frown, withdrawn, disinterested.
2– Frequent to constant quivering chin, clenched jaw.
Legs
0– Normal position or relaxed.
1– Uneasy, restless, tense.
2– Kicking, legs drawn up.
Activity
0– Lying quietly, normal position, moves easily.
1– Squirming, shifting back and forth, tense.
2– Arched, rigid or jerking.
Cry
0– No cry (awake or asleep).
1– Moans or whimpers, occasional complaint.
2– Crying steadily, screams or sobs, frequent complaints.
Consolability
0– Content, relaxed.
1– Reassured by occasional touching, hugging or being talked to, distractible.
2– Diffi cult to console or comfort.
Fig. 6. Th e FLACC scale. (From: Merkel S, et al. Th e FLACC: a behavioral scale for scoring postoperative pain
in young children. Pediatr Nurse 1997;23:293–7. Copyright 1997 by Jannetti Co. University of Michigan Medi-
cal Center.)