COMFORT B SCORE The Comfort B score indicates a level of pain child’s and sedation. Step 1: stimulate the patient: touch to the torso or score following general nursing Step 2: watch for 5 minutes to assess how your patient responds to the stimulus and then assess them using the 6 categories. (If patient ventilated use the Respiratory Response category, if not ventilated use the Cry category) Step 3: Sum numbers in each category to produce the overall Comfort B score Alertness Physical Movement 1. Deeply asleep 1. No movement 2. Lightly asleep 2. Occasional, slight 3. Drowsy movement 4. Fully awake and alert 3. Frequent, slight 5. Hyper alert movements Calmness/ Agitation 4. Vigorous movement 1. Calm limited to extremities 2. Slightly anxious 5. Vigorous movement 3. Anxious including torso and head 4. Very anxious Muscle Tone 5. Panicky 1. Muscles totally relaxed, Respiratory Response no muscle tone (Ventilated) 2. Reduced muscle tone 1. No coughing/ no 3. Normal muscle tone spontaneous ventilation 4. Increased muscle tone 2. Minimal assistance and flexion of fingers and from ventilator toes 3. Occasional cough, 5. Extreme muscle rigidity splinting or resistance to and flexion of fingers and the ventilator toes 4. Actively breathes Facial Tension against the ventilator 1. Facial muscles totally or coughs regularly relaxed 5.Fights ventilator, cough, 2. Facial muscle tone gag or choking normal, no facial tension Cry (Non-ventilated) evident 1. Quiet breathing, no 3. Tension evident in crying some facial muscles 2. Sobbing or gasping 4. Tension evident 3. Moaning throughout facial muscles
COMFORT B SCORE The Comfort B score indicates a child’s level of pain and sedation. Step 1: stimulate the patient: touch to the torso or score following general nursing Step 2: watch for 5 minutes to assess how your patient responds to the stimulus and then assess them using the 6 categories. (If patient ventilated use the Respiratory Response category, if not ventilated use the Cry category) Step 3: Sum numbers in each category to produce the overall Comfort B score Alertness 1. Deeply asleep 2. Lightly asleep 3. Drowsy 4. Fully awake and alert 5. Hyper alert Calmness/ Agitation 1. Calm 2. Slightly anxious 3. Anxious 4. Very anxious 5. Panicky Respiratory Response (Ventilated) 1. No coughing/ no spontaneous ventilation 2. Minimal assistance from ventilator 3. Occasional cough, splinting or resistance to the ventilator 4. Actively breathes against the ventilator or coughs regularly 5.Fights ventilator, cough, gag or choking Cry (Non-ventilated) 1. Quiet breathing, no crying 2. Sobbing or gasping 3. Moaning Physical Movement 1. No movement 2. Occasional, slight movement 3. Frequent, slight movements 4. Vigorous movement limited to extremities 5. Vigorous movement including torso and head Muscle Tone 1. Muscles totally relaxed, no muscle tone 2. Reduced muscle tone 3. Normal muscle tone 4. Increased muscle tone and flexion of fingers and toes 5. Extreme muscle rigidity and flexion of fingers and toes Facial Tension 1. Facial muscles totally relaxed 2. Facial muscle tone normal, no facial tension evident 3. Tension evident in some facial muscles 4. Tension evident throughout facial muscles
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