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.
The Neonatal Infant Pain Scale (NIPS) was developed by Joy Lawrence and colleagues at the Children’s Hospital of Eastern Ontario and published in 1993. It assesses procedural pain in newborns, preterm and full-term, using six behaviors that a nurse can observe at the bedside, for example during a heel prick, an injection or the insertion of a line.
The six items
| Item | 0 | 1 | 2 |
|---|---|---|---|
| Facial expression | relaxed | grimace | — |
| Cry | none | whimper | vigorous cry |
| Breathing pattern | relaxed | change in breathing | — |
| Arms | relaxed or restrained | flexed or extended | — |
| Legs | relaxed or restrained | flexed or extended | — |
| State of arousal | sleeping or awake and calm | fussy | — |
The total runs from 0 to 7. For an intubated baby, a silent cry shown by obvious mouth and facial movement is scored as a cry.
Reading the score
- 0 to 2: no pain or mild discomfort.
- 3 to 4: moderate pain; use comfort measures such as swaddling, facilitated tucking, non-nutritive sucking, oral sucrose or breastfeeding when allowed, and consider analgesia.
- Over 4: severe pain; treat and reassess.
Units set their own thresholds and protocols, and pain is reassessed after each intervention.
How to score
Observe the baby for about one minute before the procedure, during it and after it. Score each item on what you see in that period, then add the points. Comparing the scores before and after a comfort measure shows whether it worked.
Example
A baby who grimaces (1), whimpers (1), breathes faster (1) and is fussy (1) but keeps relaxed arms and legs scores 4: moderate pain.
Limits
- Very preterm or sick babies may show few behaviors even when in pain, so a low score is not proof of comfort.
- Sedation and muscle relaxants blunt the response.
- NIPS is meant for short procedures. For longer or postoperative pain, other tools such as CRIES or the EDIN scale are often used, and for older babies and toddlers, FLACC.