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Neonatal Infant Pain Scale (NIPS)

Neonatal Infant Pain Scale (NIPS) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires

Neonatal Infant Pain Scale (NIPS)
Overview: The Neonatal Infant Pain Scale (NIPS) is a behavioral assessment tool for
measurement of pain in preterm and full-term neonates. This can be used to monitor a
neonate before during and after a painful procedure such as venipuncture. It was developed
at the Children's Hospital of Eastern Ontario.
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
vigorour 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

• 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 intermittend
• 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)
• minimum score: 0
• maximum score: 7
• A falsely low score may be seen in an infant who is too ill to respond or who is
receiving a paralyzing agent.
Lawrence J Alcock D et al. The development of a tool to assess neonatal pain. Neonatal
Network. 1993; 12 (6 September): 59-66.