What it is
The Lansky Play-Performance Scale is the pediatric counterpart of the Karnofsky Performance Status, designed for children who cannot meaningfully be rated on a “work and self-care” axis. It scores overall functional status from 100 (fully active, normal) down to 0 (unresponsive) in steps of 10, using the level of play as the proxy for well-being. It is rated by the clinician from caregiver observation of how the child actually plays, and is used widely in pediatric oncology, transplant and chronic illness for stratification and tracking treatment tolerance.
The scale
Select the single level that best matches the child’s usual activity:
| Score | Descriptor |
|---|---|
| 100 | Fully active, normal |
| 90 | Minor restrictions in strenuous physical activity |
| 80 | Active, but tires more quickly |
| 70 | Greater restriction of play and less time spent in play activity |
| 60 | Up and around, but minimal active play; keeps busy with quieter activities |
| 50 | Lying around much of the day, but gets dressed; no active play, can take part in quiet play |
| 40 | Mainly in bed; participates in quiet activities |
| 30 | Bedbound; needing assistance even for quiet play |
| 20 | Sleeping often; play entirely limited to very passive activities |
| 10 | No play; does not get out of bed |
| 0 | Unresponsive |
Broadly: 80–100 is essentially normal function, 50–70 is reduced but ambulatory, 30–40 is largely bedbound, and <30 is severely limited.
When to use it
Use Lansky for children — particularly under ~16 years — who cannot be scored on Karnofsky because they do not work or attend school in the way the adult scale assumes. It is common in oncology trial eligibility and stratification, transplant work-up, and serial follow-up of any chronic illness, giving a single quantifiable functional number from observed play.
Worked example
A 5-year-old mid-chemotherapy: the parent reports she gets dressed and joins quiet table activities but no longer runs around or engages in active play, and lies down for much of the day. That maps to 50/100 — reduced function, but up and dressed. Two cycles later she is “active but tires more quickly” → 80/100, documenting functional recovery.
Pitfalls and caveats
- It is caregiver-observed and ordinal, not a measurement. Two raters can differ by a level; track the trend rather than over-reading a 10-point change.
- Pick the level that fits the whole picture, not the single best or worst moment of the day.
- Map carefully to Karnofsky. The numbers look parallel, but the anchors differ — Lansky is play-based, Karnofsky is work/self-care based — so they are conceptually analogous, not identical.
- Acute illness or a bad day can transiently depress the score — confirm it reflects the child’s usual current state.
Run it: Lansky Play-Performance Scale
Decision support for qualified clinicians only — verify against current primary guidelines and your clinical judgement.