Neonatal Infant Pain Scale (NIPS)

 

Parameters:

(1) facial expression

(2) cry

(3) breathing patterns

(4) arms

(5) legs

(6) state of arousal

 

Parameter	Finding	Points
facial expression	relaxed	0
	grimace	1
cry	no cry	0
	whimper	1
	vigorous crying	2
breathing patterns	relaxed	0
	change in breathing	1
arms	restrained	0
	relaxed	0
	flexed	1
	extended	1
legs	restrained	0
	relaxed	0
	flexed	1
	extended	1
state of arousal	sleeping	0
	awake	0
	fussy	1

 

where:

• relaxed muscles (facial expression): restful face, neutral expression

• grimace: tight facial muscles, furrowed brow, chin, jaw (negative facial expression – nose, mouth, brow)

• no cry: quiet, not crying

• whimper: mild moaning, intermittent

• vigorous cry: loud scream, rising, shrill, continuous (Note: Silent cry may be scored if baby is intubated, as evidence by obvious mouth, facial movements).

• relaxed: usual pattern for the baby

• change in breathing: indrawing, irregular, faster than usual, gagging, breath holding

• relaxed/restrained: no muscular rigidity, occasional random movements of limb

• flexed/extended: tense, straight, rigid and/or rapid extension, flexion

• sleeping/awake: quiet, peaceful, sleeping or alert and settled

• fussy: alert, restless, and thrashing

 

neonatal infant pain scale =

= SUM(points for the 6 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 7

 

Limitations:

• A falsely low score may be seen in an infant who is too ill to respond or who is receiving a paralyzing agent.