Pediatric Early Warning Signs (PEWS) are clinical manifestations that indicate rapid deterioration in pediatric patients, infancy to adolescence. PEWS Score or PEWS System are objective assessment tools that incorporate the clinical manifestations that have the greatest impact on patient outcome. Pediatric intensive care is a subspecialty designed for the unique parameters of pediatric patients that need critical care. The first PICU was opened in Europe by Goran Haglund. Over the past few decades, research has proven that adult care and pediatric care vary in parameters, approach, technique, etc. PEWS is used to help determine if a child that is in the Emergency Department should be admitted to the PICU or if a child admitted to the floor should be transferred to the PICU. It was developed based on the success of MEWS in adult patients to fit the vital parameters and manifestations seen in children. The goal of PEWS is to provide an assessment tool that can be used by multiple specialties and units to objectively determine the overall status of the patient. The purpose of this is to improve communication within teams and across fields, recognition time and patient care, and morbidity and mortality rates. Monaghan created the first PEWS based on MEWS, interviews with pediatric nurses, and observation of pediatric patients. Currently, multiple PEWS systems are in circulation. They are similar in nature, measuring the same domains, but vary in the parameters used to measure the domains. Therefore, some have been proven more effective than others, however, all of them have been statistically significant in improving patient care times and outcomes. (en)