How is pain assessed in nonverbal adults or pediatric patients?

• A. Use self-report scales only.
• B. Do not assess pain in nonverbal patients.
• C. Use observational scales like FLACC for children; for adults nonverbal, rely on behavioral cues, physiologic indicators, and caregiver input; document changes.
• D. Rely on temperature alone.

Answer: (C)

When a patient cannot speak, you assess pain by using a structured, observation-based approach and tracking changes over time. For children who are nonverbal, a validated observational tool like the FLACC scale is used. It scores five domains—Face, Legs, Activity, Cry, and Consolability—giving a reliable estimate of pain intensity even when the child cannot tell you how they feel. For adults who cannot communicate, you rely on what you can observe: behavioral cues such as facial grimacing, restlessness, guarding a body area, or vocalizations if possible, along with physiologic signs like changes in heart rate, blood pressure, respiratory rate, and sweating. Input from family or caregivers who know the person's typical pain behaviors is also valuable, since they can highlight new or worsening signs. Importantly, you document these observations and monitor for changes after analgesia or treatments, revisiting the assessment regularly to guide management. Temperature alone does not measure pain, and relying solely on self-report isn’t possible when the patient can’t communicate.