Now then. Picture a Saturday night in a children’s A&E. Strip lights, a vending machine that only takes exact change, a little one in a onesie flopped across your lap, and you sat there trying to work out whether they’re getting worse or whether you’re just knackered and frightened. Most dads have had a night like that. Plenty of us have had several.
That gap, between “I’m not sure” and “something’s really wrong”, is exactly what a new NHS change is aimed at. At the start of November, NHS England announced it is rolling out a national early warning system for children in emergency departments, and the bit that matters most for us is this. Your worry as a parent is written into it.
I first spotted it in a Netmums interview with Professor Simon Kenny, who leads on children’s care at NHS England, then went and read the official papers. Here’s what it actually is, what it isn’t, and what it means if you end up in A&E with one of yours this winter.
So what is PEWS?
PEWS stands for Paediatric Early Warning System. In plain English it’s a scoring chart. Nurses and doctors check things like heart rate, breathing rate, oxygen levels and blood pressure, write them down on a chart made for your child’s age, and get a score. The higher the score, the quicker your child should be seen and the more senior the help. The emergency department version also includes a quick check of how alert and responsive the child is.
The age bit matters. A heart rate that’s normal for a baby would be worrying in a teenager, so there are separate charts for different ages rather than one rule for everyone.
It isn’t brand new, to be fair. A version for children’s wards launched in England in November 2023, and NHS England says more than 90 hospitals are already using it on their children’s wards, with consistently lower rates of cardiac arrest among their patients. What’s new is taking it into A&E, where most of us actually turn up. Over six million children go through emergency departments in England every year, and NHS England is clear that most of them have mild illnesses that get better on their own. The hard part for staff is picking out the few who are quietly going downhill.
The bit with your name on it
Alongside the numbers, staff will ask parents and carers whether they’re worried about changes in their child. According to NHS England, a concern raised by a parent, a carer, a member of staff or the child themselves should trigger an immediate escalation of care, even if the score itself is low.
That’s a big deal. I’ve done this job long enough to know that the parent who says “she’s just not right” is often onto something before any machine is. You know what normal looks like for your kid. A nurse who’s met them ten minutes ago doesn’t.
So when they ask, actually answer. Don’t brush it off because the waiting room is rammed. And be specific about what’s different. “He’s normally chatty and he hasn’t said a word for an hour” is far more useful than “he seems poorly”. Same goes for how long since they last had a wee or a wet nappy, when they last ate or drank, and what medicine you’ve given and at what time. I’d stick that in the notes on your phone as you go, because at 2am nobody remembers whether the Calpol was at half nine or half ten.
If you still feel nobody’s listening
This is where Martha’s Rule comes in. It’s named after Martha Mills, who was 13 when she died of sepsis in hospital in 2021 after her family’s worries weren’t acted on. Her parents campaigned for it. It gives patients and families the right to ask for an urgent review of care by a different team if they think someone is getting worse and their concerns aren’t being responded to.
It started on hospital wards, and in September NHS England announced it is extending Martha’s Rule to every A&E and waiting room in England, with the rollout due to finish by March 2028. A few practical things worth knowing, all from NHS England’s Martha’s Rule page:
- There isn’t one national number. Each hospital has its own Martha’s Rule number. Look for posters, check the trust’s website, or just ask a member of staff.
- It isn’t everywhere yet, and for now it doesn’t cover urgent treatment centres or minor injury units. If your A&E hasn’t got it yet, tell staff straight away that you think your child is getting worse.
- It’s for when you think things are deteriorating and you’re not being heard. It isn’t a way to jump the queue, and often a calm word with the nurse in charge sorts it first.
As for when you’ll actually see any of this, not overnight. Don’t expect the new charts in every department this week. Hospitals in England have until April 2028 to finish switching over, and staff training goes live in December. NHS England also says it wants to bring the same approach into ambulances and community services in the coming years, which, speaking as someone on the ambulance side, would make handovers a lot tidier.
The Royal College of Nursing welcomed it, but made a fair point. A chart only works if there are enough nurses with enough time to use it properly. Anyone who has sat in a packed A&E in January will know exactly what they mean.
If you’re in Wales like me, hospitals here already use the same national PEWS charts on children’s wards, and our version of Martha’s Rule is called Call for Concern, which covers hospital inpatients. Scotland is starting to bring in Martha’s Rule too. Ask staff what’s in place wherever you are.
Don’t wait for the chart
None of this changes the basics at home. The NHS is clear that you should call 999 or go to A&E if a baby or child under 5 is breathing very fast or struggling to breathe, has blue, grey, pale or blotchy skin, lips or tongue, has a rash that doesn’t fade when you press it, isn’t responding like they normally do, is more sleepy than usual or hard to wake, has a weak, high pitched or constant cry, or hasn’t had a wee for 12 hours. That NHS page lists more, including the temperature thresholds for young babies, and it’s worth a read now rather than at 3am. If you’re not sure, NHS 111 can help you work out where to go.
And their own advice is the same as this whole change, really. Trust your instincts. If something feels wrong, say so, and keep saying so.
Siân reckons I’m the calmest person in our house in an emergency and the most useless with a sick kid at home. She’s not wrong. Turns out knowing the numbers doesn’t stop the worry when it’s your own. At least now the worry counts for something.
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