Which pain assessment tool is appropriate for a 2-year-old child?

• A. FLACC tool (face, legs, activity, cry, consolability)
• B. Numeric Rating Scale
• C. Wong-Baker FACES Pain Rating Scale for adults
• D. Visual Analog Scale

Answer: (A)

For a 2-year-old, pain assessment should be based on observable behaviors rather than asking the child to rate their pain. The FLACC scale looks at five overt, behavior-based areas—Face, Legs, Activity, Cry, and Consolability—with each area scored 0 to 2, giving a total score from 0 to 10. This makes it reliable for nonverbal or limited-verbal children ages roughly 2 months to 7 years, including toddlers, and it can be used to track changes in pain over time and guide analgesic decisions. Self-report tools like a 0–10 numeric scale or a visual analog scale require the child to understand and express pain intensity, which a 2-year-old cannot reliably do. A faces scale intended for adults isn’t appropriate for a toddler or validated for that age. The FLACC scale thus best fits the developmental level of a 2-year-old and provides a consistent method to assess pain.