PEWS Score: How Paediatric Early Warning Works

A PEWS score is a number worked out from a child's routine observations, such as breathing, heart rate, oxygen levels and alertness, that tells staff how worried to be and what to do next. PEWS stands for Paediatric Early Warning System. In England, NHS England's national PEWS charts, published in November 2023, give children's wards one standard way to score, record and escalate.

Here's how the score works, what triggers escalation, and how it connects to paediatric resuscitation and to services outside hospital.

What PEWS is for

What's normal changes a lot between a baby and a teenager, and one observation on its own can be misleading. PEWS is a "track and trigger" tool: staff record a set of observations at regular intervals, each one is scored against the expected range for the child's age, and the total points to a level of escalation and a set of actions.

Before the national charts, many hospitals had developed their own versions. The Royal College of Nursing points out that this created inconsistencies across regions, which is a problem when staff and children move between hospitals.

The national PEWS for England and the SPOT programme

The national charts came out of the System-wide Paediatric Observations Tracking (SPOT) programme, a partnership between NHS England, the Royal College of Paediatrics and Child Health and the Royal College of Nursing. NHS England describes the national PEWS observation and escalation charts as developed by clinical teams across England to standardise how deterioration in children in hospital is tracked, and designed for general children's wards.

When the charts launched, NHS England said it planned to extend the approach to emergency departments, mental health, ambulance and community services in due course. Check with your local trust which charts apply in your setting.

The national charts are for England. Scotland and Northern Ireland have their own PEWS charts.

The four age bands

Because normal heart and breathing rates change with age, there are four charts:

• 0 to 11 months
• 1 to 4 years
• 5 to 12 years
• 13 years and over

Using the wrong chart gives the wrong score, so the first check is always the child's age.

What goes into the score

We won't reproduce the chart here, and you should always use the official version your trust provides. In broad terms, the national chart asks staff to record:

• breathing rate and how hard the child is working to breathe
• oxygen saturation, and any oxygen or breathing support
• heart rate, blood pressure and capillary refill time
• level of consciousness, using the AVPU scale
• temperature, with prompts to think about sepsis

Each scored observation falls into a colour band, and the points are added up. The total puts the child into an escalation band, from low through to emergency. Higher bands mean a faster review by the nurse in charge and a doctor, and more frequent observations. The emergency band means an emergency call. Some observations are recorded without adding to the score, but they still inform the decision.

What triggers escalation: it isn't only the number

This is the part that often gets lost. The national chart builds in several triggers that don't depend on the total score:

• Parent or carer concern. Staff ask the parent or carer how their child is different since a member of staff last saw them. If the answer is "worse", that alone can trigger a review or an emergency response.
• Staff intuition. A nurse who thinks the child is "just not right" can escalate, whatever the score.
• A change in consciousness level, such as a child who now only responds to voice or pain.
• A new suspicion of sepsis. The chart prompts staff to ask "could this be sepsis?" Our sepsis awareness training covers the warning signs.

The chart also includes a structured format for handing over concerns (ISBAR) and expects the medical plan to be written down, including what should happen if the child doesn't improve.

PEWS sits alongside Martha's Rule, which NHS England is rolling out in acute hospitals for adults and children. It gives patients, families and staff a way to ask for a rapid review from a different team if they're worried someone is getting worse and they're not being listened to.

How PEWS links to paediatric resuscitation

PEWS is about prevention. The aim is to spot a child who is deteriorating early enough to act, so the team is treating breathing or circulation problems rather than starting resuscitation.

When a child does reach the emergency band, the people around them need to move quickly from recognising the problem to managing the airway, breathing and circulation, and, if needed, a paediatric cardiac arrest. Basic life support for babies and children differs from adult CPR, so staff need hands-on practice on infant and child manikins, not just a refresher video. See our paediatric first aid and basic life support training.

Using PEWS outside hospital

The national charts were designed for general children's wards. If you run a children's home, a residential service with a nursing team or another community service, follow your own policy and each child's care plan on which observation tool to use and when.

The principles carry over to any setting where staff look after children with health needs:

• Know each child's normal. Baseline observations and behaviour make changes easier to spot.
• Record observations properly, with the time, so a trend is visible across shifts.
• Take worries seriously, whether they come from a parent, a carer, the child or a colleague who feels something isn't right.
• Escalate early and clearly, using a structured handover so the person you call hears the key facts first.

For adults, the equivalent tools are different. Our guide to NEWS2 and RESTORE2 covers the adult early warning score used in care homes.

How Kasorb can help

Kasorb's paediatric immediate life support training prepares healthcare staff to recognise and treat a seriously ill or deteriorating child, and to manage a paediatric cardiac arrest as a team until specialist help takes over. It's aligned with Resuscitation Council UK guidelines.

The course covers recognising the seriously ill or deteriorating infant or child, airway and breathing management, paediatric cardiac arrest and resuscitation, using an AED on a child, choking, shock and circulatory problems, teamwork and communication during an emergency, and care after resuscitation. It runs on-site for up to 6 staff, with realistic scenarios on infant and child manikins. Your trainer has used these skills for real. It's one price for the group, and certificates are emailed the next day.

FAQs

What does PEWS stand for?

PEWS stands for Paediatric Early Warning System, sometimes called Paediatric Early Warning Score. It's a way of scoring a child's routine observations so staff can see when a child is getting worse and know how quickly to escalate. England has had national PEWS charts since November 2023.

What age groups does PEWS cover?

NHS England's national PEWS has four charts: 0 to 11 months, 1 to 4 years, 5 to 12 years, and 13 years and over. Normal ranges for breathing and heart rate change with age, so using the right chart for the child's age is the first step to an accurate score.

Can parents trigger an escalation under PEWS?

Yes. The national chart asks parents or carers how their child is different since they were last seen. If they say the child is worse, staff can escalate whatever the score. In England, Martha's Rule also gives families a route to request a rapid review from a different team.

Is PEWS the same as NEWS2?

No. NEWS2 is an early warning score for adults. PEWS is designed for children, with separate charts for different age groups because normal observations change as children grow. Both work in a similar way, scoring routine observations to show when someone needs review.

Is PEWS used in Scotland and Northern Ireland?

NHS England's national PEWS charts are for England. Scotland and Northern Ireland have their own PEWS charts, so staff there should use the version their health board or trust provides and follow local policy on escalation.