What is the best pain assessment scale for a pediatric patient, specifically a five-year-old?

Best Pain Assessment Scale for a Five-Year-Old Child

The Faces Pain Scale-Revised (FPS-R) is the most appropriate pain assessment tool for a five-year-old child due to its validated use in this age group, ease of administration, and reliable pain measurement capabilities. 1, 2

Understanding Pain Assessment in Young Children

Pain assessment in young children presents unique challenges due to their developmental stage and limited ability to articulate pain experiences. For a five-year-old specifically:

• Children at this age have limited abstract thinking abilities
• Their vocabulary to describe pain sensations may be limited
• They respond better to visual representations than numerical concepts

Recommended Pain Scale: Faces Pain Scale-Revised (FPS-R)

The FPS-R is particularly well-suited for a five-year-old for several reasons:

• Validated for this age group: Research has confirmed the FPS-R is valid for children as young as 4-5 years 2, 3
• Simple administration: Uses a standardized script that's easy to follow 1
• Visual representation: Six facial expressions showing increasing pain levels that children can easily relate to 1
• Strong psychometric properties: Shows high correlation (r=0.84-0.94) with other pain scales 1
• Avoids emotional bias: Unlike some scales, FPS-R is designed to measure pain sensation, not emotional distress 4

How to Administer the FPS-R

1. Show the child the scale with six faces
2. Use the exact script: "These faces show how much something can hurt. This face [point to face on far left] shows no pain. The faces show more and more pain [point to each from left to right] up to this one [point to face on far right]—it shows very much pain. Point to the face that shows how much you hurt [right now]." 1
3. Avoid using words like "happy" or "sad" which can confuse pain assessment with emotional state 1
4. Score from 0 (no pain) to 10 (very much pain) 1

Alternative Options and Why They're Less Suitable

Visual Analog Scale (VAS)

• Not recommended for children under 6 years 1
• Research shows weak recommendation against using VAS in children younger than 6 years with persistent pain 1

Numerical Rating Scale (NRS-11)

• Test-retest reliability significantly lower in children aged 4-6 years (0.66) compared to older children (0.82-0.97) 1
• Requires numerical understanding that may exceed a five-year-old's cognitive abilities

Wong-Baker FACES Scale

• While popular and preferred by children 4, it uses smiling and crying faces as anchors
• This can confound pain intensity with affect (emotional state) 4
• May lead to inaccurate pain assessment as children might focus on emotional expression rather than pain intensity

Special Considerations for Five-Year-Olds

Research by Decruynaere et al. 5 suggests that children aged 4-5 years can typically only distinguish between 2-3 levels of pain, not the 6 levels presented in most faces scales. By age 5, however, children begin to develop better discrimination abilities 3.

For optimal assessment in a five-year-old:

• Consider supplementing the FPS-R with observational assessment
• The FLACC scale (Face, Legs, Activity, Cry, Consolability) is validated for children 2 months to 7 years 1 and can be used alongside self-report
• Reassess pain regularly, especially after interventions 1

Implementation Tips

• Familiarize the child with the scale before pain occurs when possible
• Use consistent terminology when discussing pain
• Document baseline scores to track changes over time
• Consider using distraction techniques alongside pain assessment, as recommended for post-tonsillectomy pain management 1

The FPS-R provides the best balance of simplicity, validity, and reliability for assessing pain in a five-year-old child, making it the optimal choice for clinical practice.