What is PEWS?

PEWS is the Paediatric Early Warning System and it is a standardised clinical tool which is used to detect any early signs of deterioration of young people and children within the healthcare settings and who may need urgent attention.

What is a PEWS chart?

A PEWS chart is a recording of a child’s vital signs, such as heart rate, oxygen levels, breathing, consciousness, etc., then covert them into a score.

What ages does the PEWS chart cover?

A few age bands are covered on a PEWS chart because vital signs ranges change with age for children, these would be:

• Babies
• Young children
• Older children
• Teens

Why is PEWS important?

• Reduces the inequality of how deterioration is spotted: different hospitals used different charts and scoring systems, but a PEWS chart standardises scoring.
• Improvement of outcomes and safety: early detection, faster escalation, possibly fewer critical care admissions
• Enhances parents’ involvement: giving parents the voice even when the scores are low but the instinct of a parent tells them that something is wrong
• E-Learning and digital tools may improve consistency, speed of response and the recording of all data

A recent incident relating to PEWS in the UK

A July 2025 report on the death of a 5-year-old boy (Yusuf Mahmud Nazir) who was sent home from A&E even though his mother raised her concerns. There was an investigation which found that parental intuition was not given enough weight regarding her concerns, the report has then called for parental insight (“something feels very wrong”) is to be treated as legitimate evidence. This connects with the philosophy of “Martha’s Rule” and PEWS escalation when a parent raises their concerns.

What is Martha’s Rule?

Martha’s Rule was named after Martha Mills, a 13-year-old who died of sepsis in 2021. It is a recent initiative which is being piloted across England during 2025; it allows any healthcare staff member, patient, care giver or family member the right to request an urgent individual review of a patient after a PEWS chart has been completed but still feel their concerns are not being addressed.

Who uses PEWS?

• Ward Nurses and Paediatric Doctors: generally, PEWS is used mainly in hospitals where children may be admitted; nurses routinely measure their vital signs and complete the PEWS chart. Doctors review high scores and then make decisions on the escalation.
• Parents, carers and families: PEWS directly empowers families and carers to speak up, hospitals will need to make sure parents understand how scoring works and how to raise concerns if there are any.
• Emergency Department (ED) and ambulance crews (future rollout): at the moment, the main rollout is for inpatient wards, but pilots may have been implemented in emergency departments who admit children with plans for ambulance services and crews to be rolled out in 2026.

Just a note:

By doing a The Paediatric Early Warning System (PEWS) online training module with Train Healthcare, which takes approximately 1 hour to complete, will earn you 1 CPD point. Once you have completed the course, you will receive a certificate thereof.