NHS England is introducing a new system, the Paediatric Early Warning System (PEWS), across emergency departments in England from winter 2026. The initiative is designed to help healthcare staff identify children whose conditions are deteriorating before it is too late.
Most children arriving at A&E are seen by a triage nurse within 20 to 30 minutes of arrival to assess urgency. The new system aims to build on this by giving staff a standardised way to monitor children's wellbeing.
What the Paediatric Early Warning System involves
PEWS uses a standardised approach to track children's vital signs, including heart rate, breathing rate, oxygen levels and other signs of deterioration. Medical staff will also evaluate blood pressure, consciousness levels and more, alerting colleagues when a child's condition is worsening.
NHS England has confirmed the system is not intended to replace professional judgement or the contributions of parents, carers and children in assessing a child's condition. New standards for children's treatment in A&E are also being developed, with eliminating corridor care for young patients set to become a key priority.
Parental concerns form part of the system
Dr Sahil Nichani, a paediatric doctor, highlighted in an Instagram post that parental concerns can form part of the escalation process. He said: "So there's a new NHS patient safety initiative that's being rolled out in A&E departments across England and I want all parents to know about it."
He added: "It's called the Paediatric Early Warning System or PEWS and it's designed to help identify children who are becoming seriously unwell before it's too late."
Dr Nichani noted that parents are often "the first person to notice something isn't right" with their child. He advised: "If you're concerned, go to a member of staff and say 'I'm worried that my child is deteriorating, they're not behaving normally and I'd like them to be reassessed urgently'."
He said parents do not need to know their child's heart rate or oxygen levels to know something is wrong, adding: "You shouldn't feel uncomfortable about raising concerns because as a paediatric doctor, we understand the medicine but you understand your child. And the safety healthcare happens when we listen to both."
When to seek immediate care
Parents are advised to call 999 or head to A&E straight away if their child is struggling to breathe or their stomach is visibly sucking in beneath their ribs. Other warning signs include a developing rash, an inability to respond or remain awake, and changes in skin colour.
For babies under three months old, a temperature of 38°C (100.4°F) or above warrants immediate attention, while a baby between three and six months old should not have a temperature of 39°C (102.2°F) or higher. For non-emergencies, parents can ring 111, visit NHS 111 online, or contact their local GP for an appointment or telephone guidance.
For mild illnesses, home care may be appropriate, with children advised to get plenty of rest, fluids and comfort, and to keep the room at a comfortable temperature. Children with a fever or who feel too poorly should stay away from school or nursery until they recover.
