CRIES Pain Scale

Assesses pain in neonates based on five signs such as crying, oxygen requirement or increased vital signs.

Refer to the text below the calculator for more information about this infant pain scale.


CRIES comes from (Crying, Requires oxygen, Increased vital signs, Expression, Sleep). The scale may be taken over time to monitor the infant's (32 to 60 weeks gestational age) recovery or response to interventions.


Minimum score is 0 whilst maximum score is 10. The higher the score, the greater the expression of pain. If the CRIES score is greater than 4, further pain assessment should be undertaken, and analgesic administration is indicated for a score of 6 or higher.


1

Crying

Characteristic cry of pain is high pitched
2

Requires O2 for SaO2 < 95%

Babies experiencing pain manifest decreased oxygenation. Consider other causes of hypoxemia, e.g. oversedation, atelectasis, pneumothorax.
3

Increased vital signs (blood pressure and heart rate)

Take BP pressure test last, as this may wake the baby, making other assessments difficult.
4

Expression

The facial expression most often associated with pain is a grimace. A grimace may be characterized by brow lowering, eyes squeezed shut, deepening nasolabial furrow, or open lips and mouth.
5

Sleeplessness

This parameter is scored based upon the infant’s state during the hour preceding this recorded score.
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CRIES Pain Scale Explained

CRIES comes from (Crying, Requires oxygen, Increased vital signs, Expression, Sleep). The scale may be taken over time to monitor the infant's (32 to 60 weeks gestational age) recovery or response to interventions.

Minimum score is 0 whilst maximum score is 10. The higher the score, the greater the expression of pain. If the CRIES score is greater than 4, further pain assessment should be undertaken, and analgesic administration is indicated for a score of 6 or higher.

Item Description Answer choices
Crying Characteristic cry of pain is high pitched No crying or crying that is not high-pitched (0)
Crying is high pitched but the baby is easily consolable (+1)
Crying is high pitched and the baby is inconsolable (+2)
Requires O2 for SaO2 < 95% Babies experiencing pain manifest decreased oxygenation. Consider other causes of hypoxemia, e.g. oversedation, atelectasis, pneumothorax. No oxygen required (0)
< 30% oxygen required (+1)
> 30% oxygen required (+2)
Increased vital signs (blood pressure and heart rate) Take BP pressure test last, as this may wake the baby, making other assessments difficult. Both HR and BP unchanged or less than baseline (0)
HR or BP increased but increase in < 20% of baseline (+1)
HR or BP increased by > 20% of baseline (+2)
Expression The facial expression most often associated with pain is a grimace. A grimace may be characterized by brow lowering, eyes squeezed shut, deepening nasolabial furrow, or open lips and mouth. No grimace present (0)
Grimace alone is present (+1)
Grimace and non-cry vocalization grunt is present (+2)
Sleeplessness This parameter is scored based upon the infant’s state during the hour preceding this recorded score. Baby has been continuously asleep (0)
Baby has awakened at frequent intervals (+1)
Baby has been awake constantly (+2)

The scale has shown validity and reliability in assessing neonatal postoperative pain and is commonly accepted by neonatal nurses.

Neonates may experience pain following the disease process or therapeutic interventions. They are unable to verbalise pain and so, pain assessment requires observation, recognition and continuous monitoring. Accurate assessment through pain observation scales, such as CRIES or FLACC pain scale is crucial in adequately managing pain.

 

References

Original reference

Krechel SW, Bildner J. CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability. Paediatr Anaesth. 1995; 5(1):53-61.

Other references

Suraseranivongse S, Kaosaard R, Intakong P, et al. A comparison of postoperative pain scales in neonates. Br J Anaesth. 2006; 97(4):540-544.

Bildner, J and Krechel, SW. Increasing Staff Nurse Awareness of Postoperative Pain Management in the NICU. Neonatal Network. 1996; 15(1):11-16.


Specialty: Neonatology

Objective: Pain evaluation

Year Of Study: 1995

Abbreviation: CRIES

Article By: Denise Nedea

Published On: October 6, 2020

Last Checked: October 6, 2020

Next Review: October 6, 2025