Evidence-based guideline for pediatric resuscitation, respiratory emergencies, sepsis, febrile infant evaluation, seizures, dehydration, and common surgical emergencies in children.
A comprehensive, evidence-based clinical guideline for the evaluation, stabilization, and emergency management of critically ill and injured pediatric patients from the neonatal period through adolescence. This resource synthesizes recommendations from the major international pediatric emergency medicine, resuscitation science, critical care, and infectious disease professional societies, applied research networks, and consensus guideline groups into a single integrated reference for emergency physicians, pediatricians, pediatric intensivists, neonatologists, family medicine physicians, and advanced practice providers who care for acutely ill children.1 2 3 4 5 6 7 8 9 10
Children are not small adults. They possess distinct anatomy, physiology, pharmacology, and disease susceptibility that demand age-specific assessment strategies and weight-based therapeutic interventions. Pediatric patients represent approximately 20-25% of emergency department visits in the United States, yet critically ill children constitute a small fraction of any individual clinician’s case volume, making it essential to have structured, readily accessible clinical decision tools. Failure to recognize compensated shock, respiratory failure, or sepsis in children remains a leading cause of preventable pediatric death. This guideline provides a systematic approach to the rapid assessment and management of the most common and most dangerous pediatric emergencies, from neonatal presentations through adolescence, with emphasis on age-specific vital sign parameters, weight-based medication dosing, validated clinical decision rules, and evidence-based management algorithms.
Contents:
| Part | Title | Coverage |
|---|---|---|
| Part 1 | Pediatric Assessment & Resuscitation (PALS) | Pediatric vital signs by age (complete table); pediatric assessment triangle; weight estimation (Broselow tape, age-based formulas); PALS pulseless arrest algorithm (VF/pVT, asystole/PEA); PALS bradycardia algorithm; PALS tachycardia algorithm; weight-based resuscitation medication dosing table (epinephrine, amiodarone, adenosine, atropine, calcium, dextrose, naloxone); defibrillation and cardioversion energy; fluid bolus; equipment sizing by age/weight (ETT, LMA, blade, suction catheter) |
| Part 2 | Pediatric Respiratory Emergencies | Croup (Westley croup score, dexamethasone, nebulized epinephrine, management ladder); bronchiolitis (supportive care, HFNC, admission criteria); asthma (acute severity classification, stepwise management — albuterol, ipratropium, systemic steroids, IV magnesium, terbutaline, aminophylline); anaphylaxis (epinephrine dosing, observation); foreign body aspiration (Heimlich and back blows by age, imaging, bronchoscopy indications) |
| Part 3 | Pediatric Sepsis & Febrile Infant Evaluation | Pediatric sepsis recognition (age-specific SIRS criteria, screening tools); sepsis resuscitation (fluid bolus up to 40-60 mL/kg in first hour, vasopressor initiation, hydrocortisone indications); antibiotic selection by age and source; febrile infant approach by age (0-28 days, 29-60 days); Rochester, Philadelphia, Boston criteria comparison; PECARN febrile infant rule; neonatal CSF interpretation; empiric antibiotics (ampicillin + gentamicin, ceftriaxone, acyclovir for HSV risk) |
| Part 4 | Neurologic, Metabolic & Fluid Emergencies | Febrile seizure (simple vs complex, evaluation, education); status epilepticus protocol (benzodiazepine, levetiracetam, phenobarbital, fosphenytoin, RSI with continuous infusion); dehydration assessment (clinical dehydration scale, WHO classification); ORT protocol; IV fluid calculation (deficit + maintenance, Holliday-Segar 4-2-1 rule); hyponatremia correction; diabetic ketoacidosis (2-bag system, fluid calculations, insulin drip, cerebral edema monitoring) |
| Part 5 | Common Surgical Emergencies, Trauma & Neonatal Emergencies | Intussusception (classic triad, ultrasound target sign, air/hydrostatic enema, surgical indications); pyloric stenosis (ultrasound criteria, metabolic alkalosis); testicular torsion; pediatric trauma (PECARN head CT rule for <2 and ≥2 years, solid organ injury non-operative management, PECARN abdominal trauma rule); non-accidental trauma (sentinel injuries, screening, mandatory reporting); neonatal emergencies (hypoglycemia, congenital heart disease and PGE1, hyperbilirubinemia); pediatric medication dosing reference table |
Topjian AA, Raymond TT, Atkins D, et al. “Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.” Circulation. 2020;142(16_suppl_2):S469-S523. DOI: 10.1161/CIR.0000000000000901 ↩︎
Ralston SL, Lieberthal AS, Meissner HC, et al. “Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis.” Pediatrics. 2014;134(5):e1474-e1502. DOI: 10.1542/peds.2014-2742 ↩︎
Kuppermann N, Holmes JF, Dayan PS, et al. “Identification of Children at Very Low Risk of Clinically-important Brain Injuries After Head Trauma: A Prospective Cohort Study.” Lancet. 2009;374(9696):1160-1170. DOI: 10.1016/S0140-6736(09)61558-0 ↩︎
Weiss SL, Peters MJ, Alhazzani W, et al. “Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children.” Pediatr Crit Care Med. 2020;21(2):e52-e106. DOI: 10.1097/PCC.0000000000002198 ↩︎
Pantell RH, Roberts KB, Adams WG, et al. “Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old.” Pediatrics. 2021;148(2):e2021052228. DOI: 10.1542/peds.2021-052228 ↩︎
Subcommittee on Febrile Seizures. “Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child with a Simple Febrile Seizure.” Pediatrics. 2011;127(2):389-394. DOI: 10.1542/peds.2010-3318 ↩︎
Holmes JF, Lillis K, Monroe D, et al. “Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries.” Ann Emerg Med. 2013;62(2):107-116.e2. DOI: 10.1016/j.annemergmed.2012.11.009 ↩︎
World Health Organization. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses, 2nd ed. Geneva: WHO; 2013. URL: https://www.who.int/publications/i/item/978-92-4-154837-3 ↩︎
Gereige RS, Laufer PM. “Pneumonia.” Pediatr Rev. 2013;34(10):438-456. DOI: 10.1542/pir.34.10.438 ↩︎
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Updated 2024. URL: https://ginasthma.org/gina-reports/ ↩︎
Intussusception, pyloric stenosis, testicular torsion, PECARN head CT and abdominal trauma decision rules, solid organ injury non-operative management, non-accidental trauma screening, neonatal emergencies including hypoglycemia, congenital heart disease with PGE1, hyperbilirubinemia, and a comprehensive pediatric medication dosing reference table.
Febrile seizure evaluation, status epilepticus protocol with stepwise treatment, clinical dehydration assessment, WHO dehydration classification, ORT protocol, IV fluid calculation with Holliday-Segar rule, hyponatremia correction, and pediatric diabetic ketoacidosis management including 2-bag system and cerebral edema monitoring.
Pediatric sepsis recognition with age-specific SIRS criteria, sepsis resuscitation protocol, vasopressor selection, antibiotic guidance, febrile infant risk stratification by age, Rochester-Philadelphia-Boston criteria comparison, PECARN febrile infant rule, and neonatal CSF interpretation.
Croup scoring and management, bronchiolitis evaluation and supportive care, acute asthma severity classification and stepwise treatment, anaphylaxis recognition and epinephrine dosing, and foreign body aspiration management.
Pediatric vital signs by age, pediatric assessment triangle, weight estimation, PALS algorithms for pulseless arrest, bradycardia, and tachycardia, weight-based medication dosing, defibrillation energy, and equipment sizing.