Table 2.
Scoring and interpretation for the COMFORT-B scale. When performing the assessment, the infant is observed for 2 minutes. The healthcare professional must be in a position that permits a full view of the infant's face and body [17, 18].
| Alertness | 1 | Deeply asleep (eyes closed, no response to changes in the environment) |
| 2 | Lightly asleep (eyes mostly closed, occasional responses) | |
| 3 | Drowsy (child closes his/her eyes frequently, less responsive to the environment) | |
| 4 | Awake and alert (child responsive to the environment) | |
| 5 | Awake and hyperalert (exaggerated responses to environmental stimuli) | |
| Calmness/agitation | 1 | Calm (child appears serene and tranquil) |
| 2 | Slightly anxious (child shows slight anxiety) | |
| 3 | Anxious (child appears agitated but remains in control) | |
| 4 | Very anxious (child appears very agitated, just able to control) | |
| 5 | Panicky (severe distress with loss of control) | |
| Respiratory response (only in mechanically ventilated children) | 1 | No spontaneous respiration |
| 2 | Spontaneous and ventilator respiration | |
| 3 | Restlessness or resistance to ventilator | |
| 4 | Actively breathes against ventilator or coughs regularly | |
| 5 | Fights ventilator | |
| Crying (only in spontaneously breathing children) | 1 | Quiet breathing, no crying sounds |
| 2 | Occasional sobbing or moaning | |
| 3 | Whining (monotonous sound) | |
| 4 | Crying | |
| 5 | Screaming or shrieking | |
| Physical movement | 1 | No movement |
| 2 | Occasional, (three or fewer) slight movements | |
| 3 | Frequent, (more than three) slight movements | |
| 4 | Vigorous movements limited to extremities | |
| 5 | Vigorous movements including torso and head | |
| Muscle tone | 1 | Muscles totally relaxed; no muscle tone |
| 2 | Reduced muscle tone; less resistance than normal | |
| 3 | Normal muscle tone | |
| 4 | Increased muscle tone and flexion of fingers and toes | |
| 5 | Extreme muscle rigidity and flexion of fingers and toes | |
| Facial tension | 1 | Facial muscles totally relaxed |
| 2 | Normal facial tone | |
| 3 | Tension evident in some facial muscles (not sustained | |
| 4 | Tension evident throughout facial muscles (sustained) | |
| 5 | Facial muscles contorted and grimacing | |
| COMFORT-B score interpretation | Sedation levels: <10 oversedation, >23 undersedation [17] | |
| Pain >17 along with the numeric rating scale (NRS) > 4 indicate pain [18] NRS can be substituted for any validated pain tool | ||