For: 32-Weeks Gestation to 6 Months Old; Use for ALL Neonatal Pain Assessments, Except Surgery

Each of the five categories is scored from 0-2. The total score will be 0-10. The interdisciplinary team in collaboration with the patient/family (if appropriate) can determine appropriate interventions in response to CRIES scale scores.
CRIES SCALE 0

CRIES PAIN SCALE

CATEGO RY CryingCharacteristic cry of pain is high pitched Requires O2 for SaO2 < 95% Babies experiencing pain manifest decreased oxygenation. Consider other causes of hypoxemia, e.g., over sedation, atelectasis, Increased vital signs (BP*

SCORIN G 1

2 Cry high pitched but baby is inconsolabl > 30% oxygen required

No cry or cry Cry high that is not pitched but high pitched baby is easily No < 30% oxygen oxygen require required d Both HR and BP unchanged or less than baseline No grimace present HR or BP increased < 20% of baseline Grimace alone is present

and HR*) Take BP last as this may awaken child making other assessments difcult ExpressionThe expression most often associated with pain is a grimace characterized by brow lowering, eyes squeezed shut, deepening upon SleeplessScored based the infants state during the hour preceding this recorded score

Child has been continuous ly asleep

Child has awakened at been frequent awake intervals constantl TOTAL SCORE (0-10)

HR or BP increased > 20% over baseline Grimace and noncry vocalizatio n grunt is present Child has

Use baseline preoperative parameters from a non-stressed period. Multiply baseline HR by 0.2 then add to baseline HR to determine HR that is 20% over baseline. Do the same for BP and use the mean BP. Krechel SW & Bildner J. (1995). CRIES: A new neonatal postoperative pain measurement
scoreinitial testing of validity and reliability. Paediatric Anaesthesia, 5:53-61.

Excellence EveryDay

PAIN 4 / October

19, 2009

For: BabiesHavingSurgery; NewbornNeonates to 100 days Up of Age and 23-Weeks Gestation

A sse ssm S ed a ti ent on -1 -2 Criter Cryin No cry M oan s or w ith cries g minimall Irritabi painful stimuli y with lity painful Behavi No Arouse arou salto s or minima State any stimuli lly to stimuli No spontan Little eous spontan F a ci M ou this Minimal expressio al lax n with E x p ressi No stimuli on E xtrem it No grasp Weak reex ie s grasp Ton reex Flaccid e muscle tone tone Vital Sig n s HR, R R , BP, SaO2 No variab ility with stimuli Normal 0 Ap prop ri ate crying P ain / Agitation 2 H igh -pitch ed or silentcontinuous cry Inconsolabl Arching, kicking, constantly aw akeor arouses minimally/ no Any pain expres sion Continual clenched toes,sts or nger splay

N-PASSNEONATAL PAIN, AGITATION AND SEDATION SCALE

Irritabl e or crying at Not interv irritable Appropria R estles te for s, gestation squ irm i al age ng Aw ake ns freq u en Relaxed A ny pain Appropriat expres e sion Relaxed Intermitt hand sand ent feet clenched toes,sts Norm al or nger tone splay

< 10% Within variabilit baselin e or y from norm al for baseline gestation with al age Hypoven ti stimuli la- tion or apnea L oyo laU n iversity Health System, PRE M U RE AT L oyo laU n iversity PA IN Chicago 2002 P at H um m el A , RNC, M NNP, PNP, APN/CNP &

AS SE S S NT ME

Body is B od y is 10-20% tense > 20% from from baseli baseline ne S aO2 76 SaO 2 75% 8 5% with with stimulatio stimulation slow n + 3 if < 28 weeks gestation/ corrected age. + 2 if 2 8 -31weeks gestation/ corrected age. + 1 if 3 2 -35weeks

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