Modified Behavioral Pain Scale (MBPS) in Infants

Taddio et al modified the Behavioral Pain Scale (BPS) of Robieux et al for use with infants during office procedures such as immunizations.

The child is evaluated prior to the procedure to give a baseline for comparison during and after the procedure.

Parameters:

(1) facial expression

(2) cry

(3) movements

Parameter	Finding	Points
facial expression	definite positive expression (smiling)	0
	neutral expression	1
	slightly negative expression (grimace)	2
	definite negative expression (furrowed brow, eyes closed tightly)	3
cry	laughing or giggling	0
	not crying	1
	moaning, quiet vocalizing, gentle or whimpering cry	2
	full lunged cry or sobbing	3
	full lunged cry, more than baseline cry (scored only if child crying at baseline)	4
movements	usual movements and activity	0
	resting and relaxed	0
	partial movement (squirming, arching, limb tensing, clenching)	2
	attempt to avoid pain by withdrawing the limb where puncture is done	2
	agitation with complex/generalized movements involving the head, torso, or other limbs	3
	rigidity	3

after Table 2, page 460

where:

• Slightly negative expressions include brow bulging and naso-labial furrow.

• Definitely negative expressions include brow bulging, naso-labial furrow, eyes closed tight, open lips, with or without a reddened face.

modified behavioral pain scale =

= SUM(points for all 3 parameters)

Interpretation:

• minimum score: 0

• maximum score: 10

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