Paediatric Early Warning Score (PEWS)

This week’s health update: PEWS in A&E

A simple scoring system called the Paediatric Early Warning Score (PEWS) is being introduced in NHS emergency departments this winter. It is designed to help hospital staff spot sooner when a child may be getting worse, so they can receive urgent care earlier.

What is PEWS?

PEWS is not a diagnosis or a test. It is a way for staff to regularly measure and record a child’s vital signs—such as heart rate, breathing rate, blood pressure and oxygen levels—and turn them into a score.

A higher score means the child needs closer monitoring and, if needed, more urgent review by a senior clinician. The score is checked over time, rather than relying on one single set of observations, which can help staff notice a worrying trend before a child becomes critically unwell.

Why it matters in A&E

PEWS has been used for many years on children’s hospital wards. Its expansion into A&E means that children attending emergency departments will be assessed using the same clear, consistent approach.

The aim is simple: identify deterioration early, escalate care promptly, and avoid delays that could lead to a child becoming severely ill. NHS England says the system gives staff a structured way to track signs that a child’s condition is worsening.

Parents have a voice

One of the most reassuring parts of PEWS is that it explicitly includes the views of parents, carers and, where appropriate, the child. Staff will ask whether there have been changes in the child’s condition and whether the family is worried.

Crucially, a family’s concern can trigger an immediate escalation of care even if the numerical PEWS score is low. NHS England says these concerns will be listened to and acted upon.

This matters because parents often know their child’s usual behaviour, energy levels and “normal” better than anyone. A parent saying, “They are just not themselves,” can be an important early warning sign.

What the evidence says

Research suggests PEWS can support earlier recognition of deterioration and improve communication and teamwork among clinical staff. Studies have reported favourable trends towards fewer cardiopulmonary arrests and earlier intervention or transfer to paediatric intensive care.

However, the evidence is not perfect. A major systematic review found that while PEWS is widely used and shows promising trends, there is not yet conclusive proof that one particular version of PEWS is best, or that scores alone improve outcomes without good escalation systems, training and communication.

In other words, PEWS works best as part of a wider safety system—not as a replacement for clinical judgement or parental concern.

What parents can expect

If your child attends A&E, staff may:

• Measure and record observations such as heart rate, breathing rate, oxygen levels and blood pressure.
• Repeat these observations over time to look for changes.
• Ask whether you are worried about any change in your child.
• Increase monitoring or arrange a more senior review if the score rises or if staff or family are concerned.

The key message

PEWS gives families an extra layer of reassurance in A&E: your child’s observations are being tracked, and your concerns are part of the safety net. It does not replace a parent’s instinct—it helps make sure that instinct is heard, recorded and acted upon.

If you are ever worried that your child is getting worse, tell the team looking after them. In an emergency, call 999; for urgent advice in the UK, NHS 111 is available.