What is the Oucher?

The OUCHER is a poster developed for children to help them communicate how much pain or hurt they feel. There are two scales on the OUCHER: a number scale for older children and a picture scale for younger children.

In order to determine if a child is mature enough to rate their pain on the Oucher, you would use a simple Piagetian seriation task described in the User’s Manual and Technical Report (page 3).

Which scale should be used?

Children, who are able to count to 100 by ones or tens and who understand e.g., that 71 is larger than 43, can use the numerical scale. Children who do not understand numbers should use the picture scale. Some children who are able to use the number scale might prefer to use the picture scale. Ask the child which scale he or she would prefer.

How do I use the OUCHER?

Picture scale


The following is an example of how to explain the picture scale to a younger child.

This is a poster called the OUCHER. It helps children tell others how much hurt they have. (For younger children, it may be useful to ask: Do you know what I mean by hurt? If the child is not sure, then an explanation should be provided). Here’s how this works. This picture shows no hurt (point to the bottom picture), this picture shows just a little bit of hurt (point to the second picture), this picture shows a little more hurt (point to the third picture), this picture shows even more hurt (point to the fourth pictured), this picture shows a lot of hurt (point to the fifth picture), and this picture shows the biggest hurt you could ever have (point to the sixth picture). Can you point to the picture that shows how much hurt you are having right now?

Once children select a picture, their selection is changed to a number score from 0-10.

  • 10 – Picture at the top of the scale
  • 8 – Second picture from the top
  • 6 – Third picture from the top
  • 4 – Fourth picture from the top
  • 2 – Fifth picture from the top
  • 0 – Picture at the bottom of the scale

Number scale

The following is an example of how to explain the number scale.

This is a poster called the OUCHER. It helps children tell others how much hurt they have. Here’s how it works. 0 means no hurt. This (point to the lower third of the scale, about 1 to 3) means you have little hurts; this (point to the middle third of the scale, about 3 to 6), means you have middle hurts. If your hurt is here (point to the upper third of the sale, about 6 to 9), it means you have big hurts. If you point to 10, it means you have the biggest hurt you could ever have. Can you tell me the number your hurt is right now?

The pain score for the number scale is the exact number from 0-10 that the child gives you.

What does the score mean? How should it be used?


The person who has the pain is the expert or the one who know best how the pain feels. The OUCHER score gives parents, teachers, nurses, doctors and others some idea of how much pain the child is feeling. OUCHER scores can be used as a means to see whether or not certain actions used to relieve pain, such as rest, applying heat or cold, eating or drinking, and medicine make a difference in how much pain the child feels. OUCHER scores can be recorded over a period of hours or days and would be useful information to share with nurses and doctors.

Remember, OUCHER scores only communicate how much pain the child is feeling. Other observations, such a changes in activity, location of the pain, what it feels like, and how long it lasts are also important. If you are concerned about the children pain, you should contact your health care provider.

©The Caucasian version of the OUCHER was developed and copyrighted by Judith E. Beyer, PhD, RN, USA, 1983. The African-American version was developed and copyrighted by Mary J. Denyes, PhD, RN, and Antonia M. Villarruel PhD, RN, USA, 1990. Cornelia Porter PhD RN and Charlotta Marshall RN, MSN contributed to the development of the scale. The Hispanic version was developed and copyrighted by Antonia M. Villarruel, PhD, RN and Mary J. Denyes, PhD, RN, USA, 1990. The First Nations Oucher, developed and copyrighted by Carla Shapiro, RN, MN, Canada, 1997. The Asian versions (male and female) were developed and copyrighted by C.H. Yeh, PhD, RN and C.H. Wang , B.S.N., Taiwan, 2003.

For more information about the OUCHER, write to Dr. Judith E. Beyer, P.O. Box 411714, Kansas City, MO 64141, go to www.Oucher.org, and email at jbeyer@kc.rr.com.