Example<unk>  assessment chart Assessment of<unk>  in<unk>  depends on the cooperation and developmental stage of the child. Some<unk>  cannot assist in their assessment because they have not matured enough cognitively, emotionally, or physically. The following sections list signs of distress and possible<unk>  in<unk>  by age group: Younger infants * Inability to distinguish the stimulus from the<unk>  * Ability to exhibit a reflexive response to<unk>  * Expressions of<unk>  * Tightly closed eyes * Open mouth resembling a square rather than an oval or circle * Eyebrows lowered and tightly drawn together * Rigid body * Thrashing * Loud crying * Increase in heart rate, even while sleeping Older infants * Deliberate withdrawal from<unk>  and possible guarding * Loud crying *<unk> ful facial expressions Toddlers Toddlers show signs of distress and possible<unk>  by: * Expressing<unk>  verbally * Thrashing extremities * Crying loudly * Screaming * Being uncooperative * Palpating (examining with the hands) a source of<unk>  * Anticipating a<unk> -inducing procedure or event * Requesting to be comforted * Clinging to a significant person, possibly one perceived as protective School-age<unk>  School-age<unk>  show signs of distress and possible<unk>  by: * Anticipating the<unk>  but less intensively, (understands concepts of time, i.e., imminent vs future<unk>  * Stalling, trying to talk out of the situation where<unk>  is anticipated * Having muscular rigidity Adolescent Adolescents show signs of distress and possible<unk> : * With muscle tension, but with control * With verbal expressions and descriptions Quantitative<unk>  assessment Although<unk>  is subjective and can occur in a continuous spectrum of intensities, there are assessment tools that compare<unk>  levels over time. This kind of assessment incorporates<unk>  scales and requires a high enough developmental level for the child to respond to questions. A verbal response is not always necessary to quantify<unk> .<unk>  scales A<unk>  scale measures a patient's<unk>  intensity and other features.<unk>  scales can be based on observational (behavioral) or physiological data, as well as self-report. Self-report is considered primary and should be obtained if possible.<unk>  measurements help determine the severity, type, and duration of<unk> . They are also used in diagnosis, to determine a treatment plan, and to evaluate the effectiveness of treatment.<unk>  scales are available for neonates, infants,<unk> , adolescents, adults, seniors, and persons with impaired communication.<unk>  assessments are often regarded as "the 5th vital sign". + Examples of<unk>  scales Self-report Observational Physiological Infant — Premature Infant<unk>  Profile; Neonatal/Infant<unk>  Scale — Child Wong-Baker Faces<unk>  Rating Scale – Revised; Coloured Analogue Scale FLACC (Face Legs Arms Cry Consolability Scale); CHEOPS<unk> 's Hospital of Eastern Ontario<unk>  Scale) Comfort Adolescent Visual Analog Scale (VAS); Verbal Numerical Rating Scale (VNRS); Verbal Descriptor Scale (VDS); Brief<unk>  Inventory — —
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