What it is
The Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) is an observational post-operative pain tool for children aged 1–7 years who cannot reliably self-report. The observer rates six behaviours; because each item has a non-zero minimum, the total ranges from 4 (no pain) to 13 (worst pain) — not 0–13. It is more granular than three-item scales like BOPS, at the cost of being a little slower to score.
The six domains
Each item is scored within its own range — note that some start at 1, which is why the floor is 4, not 0.
| Domain | Scoring |
|---|---|
| Cry | 1 no cry · 2 moaning/crying · 3 scream |
| Facial | 0 smiling · 1 composed/neutral · 2 grimace |
| Child verbal | 0 positive / talks of other things · 1 none or other complaints · 2 pain complaints |
| Torso | 1 neutral · 2 shifting / tense / shivering / upright / restrained |
| Touch (wound) | 1 not touching · 2 reaching / touching / grabbing / restrained |
| Legs | 1 neutral · 2 squirming / kicking / drawn up / standing / restrained |
Sum the six items for the total (minimum 4, maximum 13).
Interpreting the total
- 4 — no / minimal pain.
- 5–7 — mild to moderate pain.
- ≥8 — significant pain; treat.
Any score >4 suggests some pain. Many units use ≥8 as the threshold for significant pain warranting analgesia, though some protocols intervene earlier (≥6). Follow your local pathway, and use the number to drive a reassess loop — score, treat, re-score after the analgesic’s expected onset.
When to use it
Use CHEOPS in the post-operative / recovery setting for young children who cannot self-report, especially when you want more behavioural granularity than a three-item scale provides. Once a child can reliably use a self-report tool, self-report takes precedence.
Worked example
A 4-year-old, post-tonsillectomy: moaning (Cry 2), grimace (Facial 2), pain complaints (Verbal 2), shifting and tense (Torso 2), reaching for the wound (Touch 2), legs drawn up (Legs 2) = 12/13 — significant pain. After analgesia, re-scored: no cry (1), composed (1), talks of other things (0), neutral torso (1), not touching (1), neutral legs (1) = 5/13, mild — a documented response.
Pitfalls and caveats
- The minimum is 4, not 0. Reading a “4” as a low fraction of a 0–13 scale will misclassify a comfortable child as being in pain — 4 means no pain.
- It is an observed-behaviour score, not nociception. A withdrawn or exhausted child can under-score.
- Distress is non-specific — fear, hunger, emergence agitation and unfamiliar surroundings all raise it. Interpret in context.
- Validated for 1–7 years, post-operatively. Score the trend around an intervention, not a single isolated number.
Run it: CHEOPS Pain Scale
Decision support for qualified clinicians only — verify against current primary guidelines and your clinical judgement.