The Pediatric Early Warning Score (Brighton PEWS) is a bedside scoring system that combines behaviour, cardiovascular and respiratory parameters into a single score (0–9) to identify children who are at risk of clinical deterioration. Higher scores correlate with PICU admission, cardiac arrest and mortality.

PEWS is now embedded in NHS, AAP and IAP-endorsed pediatric early warning systems and is required by NABH/JCI accreditation for pediatric wards.

• At every nursing observation set (typically 4-hourly on wards).
• At ED triage for any child looking unwell.
• Post-operatively in the first 24 hours.
• Whenever parents say "my child looks different" — parental concern can be the strongest predictor.

• < 1 year: HR 110-160, RR 30-60
• 1-3 years: HR 90-150, RR 24-40
• 4-5 years: HR 80-140, RR 22-34
• 6-12 years: HR 70-120, RR 18-30
• > 12 years: HR 60-100, RR 12-20

India's pediatric hospital mortality remains high (~3-5% in tertiary centres) partly due to delayed recognition. PEWS implementation in Indian centres (AIIMS, CMC Vellore, PGIMER) has reduced unplanned PICU admissions by 30-40%. Practical points:

• Print laminated age-band cards (HR/RR) at the bedside.
• Train staff nurses on the "parent concern" trigger — culturally Indian parents often hesitate to escalate.
• Use PEWS as a hand-off tool during shift changes.
• Audit PEWS-triggered escalations monthly for the M&M committee.