When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Sepsis in children

Last reviewed: 6 Nov 2023
Last updated: 22 Sep 2023



History and exam

Key diagnostic factors

  • fever or low body temperature
  • tachypnea
  • tachycardia
  • bradycardia (neonates and infants)
  • altered mental state or behavior
  • decreased peripheral perfusion
  • change in usual pattern of activity or feeding in a neonate
  • dry diapers/decreased urine output
  • mottling of the skin, ashen appearance, cyanosis
  • low oxygen saturation
  • vasoplegia
  • nonblanching purpuric rash
More key diagnostic factors

Other diagnostic factors

  • hypotension
  • specific focal signs and symptoms reflecting underlying pathology
Other diagnostic factors

Risk factors

  • immunodeficiency
  • comorbidities
  • male sex
  • younger age (especially neonates)
  • perinatal risk factors for infection (neonates)
  • healthcare-associated factors (neonates)
  • recent surgery or other invasive procedures
  • breached skin integrity
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC with differential
  • serum glucose
  • blood culture
  • urinalysis
  • urine culture
  • blood gases
  • serum lactate
  • serum electrolytes
  • serum creatinine
  • LFTs
  • coagulation studies
  • C-reactive protein (CRP)
  • chest x-ray
More 1st investigations to order

Investigations to consider

  • lumbar puncture
  • meningococcal polymerase chain reaction analysis
  • bronchoalveolar lavage culture
  • herpes simplex virus (HSV) polymerase chain reaction (blood and cerebrospinal fluid)
More investigations to consider

Emerging tests

  • serum procalcitonin
  • emerging biomarkers
  • PhenoTest™ BC Kit

Treatment algorithm


presumed or confirmed sepsis



Akash Deep, MD, FRCPCH

Director and Professor of Paediatric Critical Care

Paediatric Intensive Care Unit

King’s College Hospital




AD declares that he has no competing interests.

Chris Duncan, BMBS, BMedSci, MRCP, FFICM, FEWM, RMP, PGCert

Professorial Fellow

Intensive Care Medicine

Nepean Hospital




CD declares that he has no competing interests.


Dr Akash Deep and Dr Chris Duncan would like to gratefully acknowledge Dr Jeremy Tong and Dr Adrian Plunkett, previous contributors to this topic.


JT and AP are authors involved in the Pediatric Sepsis Six initiative, cited in this topic.

Peer reviewers

Saul N. Faust, MA, MBBS, FRCPCH, PhD, FHEA

Professor of Paediatric Immunology & Infectious Diseases

Director, NIHR Wellcome Trust Clinical Research Facility

University of Southampton




SNF declares that he has no competing interests.

Mohan Pammi, MBBS, MD, MRCPCH

Assistant Professor

Texas Children's Hospital and Baylor College of Medicine




MP declares that he has no competing interests.

Jerry J. Zimmerman, MD, PhD

Faculty, Pediatric Critical Care Medicine

Seattle Children's Hospital

University of Washington School of Medicine




JJZ receives research grant support from NIH/NICHD and ImmuneXpress; travel reimbursement from the Society of Critical Care Medicine to attend board meetings; and royalties from Elsevier for action as a co-editor for the textbook Pediatric Critical Care.

  • Sepsis in children images
  • Differentials

    • Coronavirus disease 2019 (COVID-19)
    • Pediatric inflammatory multisystem syndrome
    • Congenital heart disease
    More Differentials
  • Guidelines

    • Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2021
    • Neonatal infection: antibiotics for prevention and treatment
    More Guidelines
  • Patient leaflets

    Sepsis in children

    Pneumococcal vaccine in babies and children

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer