This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Newborns feel pain, and untreated pain after surgery has short- and long-term effects. Because they cannot tell anyone, nurses rely on behavior and vital signs. The CRIES score, published by Krechel and Bildner in 1995 for babies from 32 weeks of gestation, is one of the most used tools for postoperative pain in neonatal units. Its name lists the five items: Crying, Requires oxygen, Increased vital signs, Expression and Sleeplessness.
The score
| Item | 0 | 1 | 2 |
|---|---|---|---|
| Crying | no cry, or not high-pitched | high-pitched, consolable | inconsolable |
| Requires O2 for saturation above 95% | none | 30% or less | more than 30% |
| Increased vital signs | heart rate and blood pressure at or below baseline | either up by less than 20% | either up by 20% or more |
| Expression | none | grimace | grimace with grunting |
| Sleeplessness | no | wakes at frequent intervals | constantly awake |
The total runs from 0 to 10. Vital signs are compared with the values taken before surgery.
Example
A baby with a high-pitched cry that settles when held (1), no extra oxygen (0), a heart rate 15% above baseline (1), a grimace (1) and normal sleep (0) scores 3.
Interpretation
| CRIES | Usual response |
|---|---|
| 0 to 2 | little or no pain |
| 3 to 4 | some pain: comfort measures and close reassessment |
| more than 4 | significant pain: give analgesia and reassess |
The original authors recommended pain treatment for scores above 4. Units often add comfort measures from lower scores: swaddling, skin-to-skin contact, non-nutritive sucking or sucrose for procedures.
When to score
Score every hour for the first hours after surgery, then every 2 to 4 hours, and again after any pain medicine, at the time it should work.
Limits
Oxygen need and vital signs can rise for reasons other than pain, such as lung disease, fever or blood loss, and sedated or very preterm babies may show little behavior even when in pain. Interpret the score with the whole clinical picture and the unit’s protocol.