How to ask your child
Many children can use a faces scale from about the age of four. What matters is that your child shows how strong the pain is, not what mood they are in.
- Say something like "Show me how much it hurts." Leave out words like "happy" or "sad". Otherwise your child may point to how they feel rather than how strong the pain is.
- Explain the faces once, calmly, before anything hurts, for example with the poster on the fridge. Then your child already knows the scale when it matters.
- Accept the face your child picks, even if you would have judged it differently. Comments such as "It can't be that bad" teach children to guess what you want to hear.
- Ask at set times, such as after school and before bed, instead of checking all the time.
- Next to the score, note where it hurts, what your child was doing and what helped. Also note who asked.
Which scale suits which age
The ages are rough guides. Whether your child understands the scale matters more than age. Once you have chosen one, stick with it for weeks so the scores stay comparable.
| Age (approx.) | Method | How it works |
|---|---|---|
| under 4 | Observation by an adult | Watch face, legs, restlessness, crying and whether the child can be comforted, and describe it in words. |
| from about 4 | Faces scale | The child points to a face and you note the score 0, 2, 4, 6, 8 or 10. |
| from about 8 | Number scale 0 to 10 | "0 means no hurt at all, 10 the worst hurt you can imagine." |
For older children, teenagers and adults there is our scale with all eleven levels: Pain scale 0 to 10 with all levels
Why children need their own pain scale
Young children are often good at showing pain but bad at putting it into numbers. "Seven out of ten" is an abstract task for a preschooler. A face, by contrast, turns the feeling into a picture they can point to. That way the rating comes from the child, which is the point: the person in pain is usually the best judge of it.
The faces on this page range from neutral to strongly pinched. The left face deliberately does not smile. Otherwise some children would pick the smiling face because they are in a good mood, even though something hurts.
Validated scales and this simplified guide
Hospitals and research studies often use the Faces Pain Scale – Revised (FPS-R). It was published in 2001 by Hicks and colleagues and tested with children aged roughly four to twelve. The International Association for the Study of Pain (IASP) provides it with instructions in many languages. Clinical use is free as long as the scale is not changed; for publication and commercial use the IASP grants licences.
The faces here are our own simplified drawings. They follow the same logic of six steps from 0 to 10 but have not been scientifically tested. For parents at home they work as a rough guide. If your child's doctor or hospital uses the FPS-R or another scale, use the same one so that everyone is talking about the same scores.
When children cannot point yet
Babies and toddlers under about four cannot use a scale yet. Health professionals use observation tools instead. Internationally the FLACC is widespread. Its name stands for the five areas to watch: face, legs, activity, cry and consolability. In German-speaking countries the KUSS (a children's discomfort and pain scale by Buettner) is common.
As a parent you do not need to fill in any of these forms. Describe in words what you see, for example "pulls up his legs, won't be put down, calms down when held". Notes like these help the doctor more than an estimated number.
Comparing scores over days
A single score says little. The scale becomes useful when you ask at similar times over a few days or weeks and record the good days too. Then you can see whether tummy aches mainly happen on school days, whether the hot water bottle helps or whether the scores slowly go down. A simple pain diary, on paper or right in your browser, is enough for the notes.
Embed the faces scale on your own site
For practices, nurseries, care services and parenting blogs: copy the code into your page. The scale runs in a frame without cookies or tracking, and the link underneath leads to this guide.
Preview
Frequently asked questions
From what age does a faces pain scale work?
Many children can use one from about four. With younger children you observe their behaviour. From about eight, most children can use the number scale from 0 to 10.
What do the numbers under the faces mean?
The six faces stand for the scores 0, 2, 4, 6, 8 and 10. That makes the score comparable with the usual 0 to 10 scale, for example in a pain diary or when talking to the doctor.
Why shouldn't I ask whether my child feels sad?
Because the scale is meant to capture how strong the pain is. If you ask about feelings, your child may pick the face that matches their mood. You can note the mood separately.
Is this the Faces Pain Scale – Revised?
No. The faces here are our own simplified drawings with the same steps. For clinical care and research the validated FPS-R provided by the IASP is the right tool.
Can I print or embed the scale?
Yes, both are free. You can print the A4 poster straight from this page, and websites can use the embed code above.
Read more
Sources
- IASP: Faces Pain Scale – Revised (FPS-R), instructions and translations
- Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B (2001): The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement. Pain 93(2): 173-183
- von Baeyer CL et al. (2009): Three new datasets supporting use of the Numerical Rating Scale (NRS-11) for children's self-reports of pain intensity. Pain 143(3): 223-227
- Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S (1997): The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 23(3): 293-297
- Buettner W, Finke W (2000): Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children. Paediatr Anaesth 10(3): 303-318
- German Paediatric Pain Centre (Deutsches Kinderschmerzzentrum), Datteln (in German)
In the PainTrack app you choose a 0 to 10, yes/no or mild/moderate/severe scale when you create a pain. Enter the score of a face on the 0 to 10 scale and put your child's own words in the note.
This faces scale is a simplified guide and not a medical device. It does not replace a medical examination, diagnosis or treatment.