This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Children in hospital often look well until they suddenly do not: their heart and breathing compensate for a long time, then fail quickly. Early warning scores turn routine observations into a single number that tells the nurse when to call for help. The Pediatric Early Warning Score (PEWS) described by Monaghan at the Royal Alexandra Children’s Hospital in Brighton in 2005 is the best known, and many hospitals use a version of it.
The score
| Points | Behavior | Cardiovascular | Respiratory |
|---|---|---|---|
| 0 | playing, appropriate | pink, capillary refill 1 to 2 s | normal rate, no retractions |
| 1 | sleeping | pale, refill 3 s | rate 10 above normal, accessory muscles, 30% FiO2 or 3 L/min |
| 2 | irritable | gray, refill 4 s, or heart rate 20 above normal | rate 20 above normal, retractions, 40% FiO2 or 6 L/min |
| 3 | lethargic, confused, reduced response to pain | gray and mottled, refill 5 s or more, heart rate 30 above normal, or bradycardia | rate 5 below normal with retractions or grunting, 50% FiO2 or 8 L/min |
Add 2 points for nebulized treatment every 15 minutes and 2 points for persistent vomiting after surgery. The total runs from 0 to 13.
Example
A sleeping child (1) who is pale (1) with a breathing rate 10 above normal (1) scores 3: tell the nurse in charge and check more often.
Interpretation
| PEWS | Usual response |
|---|---|
| 0 to 2 | routine observations |
| 3 | inform the nurse in charge, observe more often |
| 4 | inform the physician, increase monitoring |
| 5 or more, or 3 in any category | urgent medical review, consider the rapid response team |
Hospitals set their own thresholds and actions, so follow the local escalation chart.
Normal ranges by age
“Above normal” is judged against the child’s age. As a rough guide, the resting heart rate is about 100 to 160 beats per minute in infants, 90 to 140 in toddlers, 80 to 120 at school age and 60 to 100 in teenagers; the breathing rate falls from 30 to 60 breaths per minute in infants to 12 to 20 in teenagers.
Limits
PEWS supports, but never replaces, the concern of parents and staff: a worried nurse or parent is a reason to call for review whatever the score. It is less accurate in children with chronic heart or lung disease, whose baseline is abnormal.