Paediatric Early Warning Scores (PEWS): A Guide for Nurses

Children can look well until they suddenly don’t. Paediatric early warning scores help nurses spot deterioration early and escalate in time.

Imagine a mother telling you her toddler “just isn’t himself” while his observations look borderline. A PEWS chart and her concern together tell you to call for help now.

What PEWS is

PEWS charts track observations such as breathing rate, effort of breathing, oxygen levels, heart rate, behaviour and capillary refill, using age-specific normal ranges. Rising scores prompt escalation.

Why age matters

Normal heart and breathing rates are very different for babies, toddlers and teenagers. Using the right age chart is essential.

Listening to families

Many PEWS systems now include parent or carer concern as a trigger for review. In England, the national PEWS (part of the System-wide Paediatric Observations Tracking programme) includes this.

Good practice

• Count breathing for a full minute
• Observe work of breathing, not just the number
• Use the correct age chart
• Escalate when the score or your concern rises
• Document clearly and recheck

Frequently asked questions

Does a low score mean the child is safe?

Not always. Your clinical judgement and parent concern still matter.

How is PEWS different from NEWS2?

NEWS2 is for adults. PEWS uses age-specific ranges for children.

But the score is normal

Scores support judgement; they don’t replace it. If you are worried, escalate.

Sources: NHS England national PEWS programme, Royal College of Paediatrics and Child Health, Institute for Healthcare Improvement.