TABLE 1.

The Neonatal Infant Pain Scale

Pain Assessment Tools
Neonatal/Infant Pain Scale (NIPS)
Recommended for Children less than 1 year old – A score greater than 3 indicates pain
Pain assessment		Score
Facial expression
0‐Relaxed muscles	Restful face, neutral expression
1‐Grimace	Tight facial muscles; furrowed brow, chin, jaw, (negative facial expression – nose, mouth and brow)
Cry
0‐No Cry	Quiet, not crying
1‐Whimper	Mild moaning, intermittent
2‐Vigorous cry	Loud scream; rising, shrill, continuous (Note: Silent cry may be scored if baby is intubated as evidenced by obvious mouth and facial movement.)
Breathing patterns
0‐Relaxed	Usual pattern for this infant
1‐Change in breathing	Indrawing, irregular, faster than usual; gagging; breath holding
Arms
0‐Relaxed/Restrained	No muscular rigidity; occasional random movement of arms
1‐Flexed/Extended	Tense, straight arms; rigid and/or rapid extension, flexion
Legs
0‐Relaxed/Restrained	No muscular rigidity; occasional random leg movement
1‐Flexed/Extended	Tense, straight legs; rigid and/or rapid extension, flexion
State of arousal
0‐Sleeping/Awake	Quiet, peaceful sleeping or alert random leg movement
1‐Fussy	Alert, restless, and thrashing

Notes: The NIPS ¹³ was developed at Children's Hospital of Eastern Ontario. The NIPS assesses six behavioural indicators in response to painful procedures in preterm newborns (gestational age < 37 weeks) and full‐term newborns (gestational age > 37 weeks to 6 weeks after delivery). Table adapted from the Pain Assessment and Management Initiative (https://pami.emergency.med.jax.ufl.edu/wordpress/files/2019/10/Neonatal‐Infant‐Pain‐Scale‐NIPS.pdf).