Paediatric sepsis

The National Institute for Health and Care Excellence (NICE) guidelines for suspected sepsis in people under 16 years old were updated in November 2025. The focus is on recognition, diagnosis and early management of the condition. The World Health Organization (WHO) has declared sepsis as a priority in health, as in some cases it can be preventable (WHO, 2024).
Sepsis in children may present initially with non-specific, non-localised symptoms especially in younger children so it is important to have a low threshold for suspecting sepsis (BMJ, 2025). Progression to organ failure and shock can be very rapid; therefore, early recognition and treatment are crucial for sepsis (BMJ, 2025; NICE, 2025). It is also one of the main causes of childhood death.
Sepsis can also lead to morbidity and lifelong challenges for children. There is an increase in the incidence of morbidity related to survivorship, with 28–34% of children being identified as

Sepsis is an abnormal host response to an infection that can result in life-threatening organ failure (Minogue et al, 2024; WHO, 2024). While most clinicians associate bacterial infection with sepsis, viruses, fungi, and parasites can also lead to sepsis (Bracken et al, 2023). In 2020, there were 48.9 million cases and 11 million sepsis-related deaths globally, with an estimated 20 million cases occurring in children under 5 years of age (WHO, 2024). It is certainly one of the main causes of childhood death. In the UK around 245 000 people develop sepsis (Rudd et al, 2020). It has been estimated that approximately 40% of those who recover from sepsis develop cognitive or functional impairment (Prescott and Angus, 2018).

The NICE (2025) guidelines for suspected sepsis in people under 16 years old were updated in November 2025 [Insert link to guidelines]. The focus is on recognition, diagnosis and early management of the condition.
NICE (2025) recommends that sepsis should be considered as a possible differential diagnosis if a person presents with symptoms or signs that indicate possible infection. They also suggest that children do not always present in a typical way and that they may have a non-specific, non-localised presentation – just feeling very unwell. They may not even have a high temperature. However, this can lead to children being over diagnosed and overtreated because of the unclear pattern of sepsis (Bradford‐Duarte et al, 2023). This is demonstrated in Bradford‐Duarte et al’s (2023) study of the overdiagnosis of chest sepsis in children.
When assessing children for sepsis, it is important to have a comprehensive history and identification of risk factors (NICE, 2025). Children in  low sociodemographic index regions are more vulnerable to sepsis and there are also geographical, and people factors, which include differences in healthcare provision, vaccination, and pathogen prevalence (Bracken et al, 2023).

There are clear guidelines on managing risk of severe illness or death outside acute hospital settings (NICE, 2025). Any child with suspected sepsis should be referred to hospital for immediate emergency care. The protocol for paediatric patients includes the following steps to be initiated immediately upon suspicion of sepsis (NICE, 2025):

• Administer high-flow oxygen to maintain adequate oxygen saturation
• Take blood cultures before starting antibiotics to identify the causative organism
• Administer intravenous broad-spectrum antibiotics within one hour of admission
• Follow the guidelines for intravenous fluids.

BMJ. BMJ Best Practice. Sepsis. https://bestpractice.bmj.com/topics/en-gb/1201 (accessed 28 November 2025)

Boeddha NP, Schlapbach LJ, Driessen GJ, Herberg JA, Rivero-Calle I, Cebey-López M, Klobassa DS, Philipsen R, de Groot R, Inwald DP, Nadel S, Paulus S, Pinnock E, Secka F, Anderson ST, Agbeko RS, Berger C, Fink CG, Carrol ED, Zenz W, Levin M, van der Flier M, Martinón-Torres F, Hazelzet JA, Emonts M; EUCLIDS consortium. Mortality and morbidity in community-acquired sepsis in European pediatric intensive care units: a prospective cohort study from the European Childhood Life-threatening Infectious Disease Study (EUCLIDS). Crit Care. 2018 May 31;22(1):143. doi: 10.1186/s13054-018-2052-7.

Bracken A, Lenihan R, Khanijau A et al. The Aetiology and Global Impact of Paediatric Sepsis. Curr Pediatr Rep 2023;11:204–213. doi.org/10.1007/s40124-023-00305-3

Bradford-Duarte R, Wood D. Paediatric teaching and training for GP trainees: the perceived adequacy in preparing for the assessment of children in primary care. London Paediatrics. 2023;4.
de Souza DC, Paul R, Mozun R, Sankar J, Jabornisky R, Lim E, Harley A, Al Amri S, Aljuaid M, Qian S, Schlapbach LJ, Argent A, Kissoon N. Quality improvement programmes in paediatric sepsis from a global perspective. Lancet Child Adolesc Health. 2024 Sep;8(9):695-706. doi: