Paediatric Early Warning Score (PEWS)

Making hospitals safer for children

The Paediatric Early Warning System (PEWS) provides a framework for care and empowers clinicians to act on behalf of a child with signs of deterioration or about whom they have clinical concerns.

It is designed to make hospital admissions safer for children and help staff care for deteriorating paediatric patients.

A National Clinical Guideline on the Irish Paediatric Early Warning System (PEWS) was published by the National Clinical Effectiveness Committee and Department of Health in November 2015 and updated in November 2016.

Download the PEWS National Clinical Guideline (

Since this time the International Sepsis Guidelines for Children Implementation Plan 2021 and Paediatric Sepsis Form (together the Sepsis Guidelines) have been developed and published by the HSE National Clinical Programme for Sepsis. 

Designed to be used in all hospitals

PEWS is designed to be used in tertiary, regional and peripheral hospital settings.

It takes a multifaceted approach to improving clinical outcomes using safety interventions such as:

  • National paediatric observation charts incorporating the PEWS scoring tool
  • Escalation guide
  • Standardised communication (ISBAR)
  • Timely medical and nursing input
  • Clear documentation of management plans
  • Ongoing reassessment of the child

Resources for Training and Support

These resources replace all earlier editions and are correct from June 2023 when changes were made to align these resources with new Sepsis Guidelines for Children

Implementation Toolkit

This toolkit contains the resources required by PEWS Governance Committees and senior management teams considering the implementation of PEWS.

The PEWS National Clinical Guideline ( provides the framework for implementation and should be referred to for guidance.

Training Toolkit

This toolkit contains the resources required by the PEWS leads, Trainers and Champions to facilitate training for implementation and ongoing retraining/updates.

You must refer to the PEWS National Clinical Guideline ( the specific guidance for implementation / training when accessing and using these services.

Audit Toolkit

The resources in this toolkit are to aid PEWS Governance bodies, leads, trainers and champions to undertake audit of process and outcome measures, as required by the PEWS National Clinical Guideline (

These resources are also required by the HSE BIU KPIs suite requirements.

Parent / Carer Engagement Toolkit

We recognise that parents and carers know their children best and can be acutely aware that their child is unwell or ‘just not right’, sometimes before the physiological parameters become abnormal.

The concerns of parents, families and caregivers are a core scoring parameter in PEWS. An assessment of parent/carer concern is undertaken at every observation opportunity. Concern on the part of a parent /carer should merit appropriate consideration and may require escalation.

The resources in this toolkit will assist the bedside clinician in supporting parents to participate in the concern assessment and to aid parents in expressing their concern about their child.

These resources were adapted with kind permission from Birmingham Children’s Hospital Listening to up communication bundle. We are grateful for their support of this project.