Pediatric Specialty

Pediatric SBAR Template

Engineered specifically for pediatric nursing and clinical handoffs. Accounts for age-dependent vital sign ranges, mandatory exact kilogram weights, the Pediatric Assessment Triangle (PAT), developmental observations, and weight-based dosing.

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Why Pediatric SBAR Context Differs

Children are not miniature adults. Pediatric physiological compensation masks shock until abrupt, rapid decompensation occurs. Pediatric SBAR replaces adult assumptions with exact kilogram weights, age-specific vitals interpretation, and the Pediatric Assessment Triangle (Appearance, Breathing, Circulation).

Mandatory Weight (kg): Stated in every communication for safety in mg/kg dosing and fluid bolus calculations (20 mL/kg).

Pediatric Assessment Triangle: Structured evaluation of Appearance (tone/consolability), Work of Breathing, and Skin Circulation.

Parent / Caregiver Context: Parental concerns, baseline behavior, and feeding/hydration status.

Available SBAR Formats

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Word (.DOCX)Editable table template for MS Word

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Interactive

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Pediatric Clinical Example

Severe Bronchiolitis Escalation

Clinical FrameworkSTAT / Emergent

Pediatric Inpatient Nurse-to-Hospitalist Emergency SBAR

Acute respiratory deterioration and PICU step-up evaluation

Patient: Lucas Morales (4yo M, 16.0 kg)

Bed/Room: Peds Room 204

MRN: MRN-774102

Attending: Dr. Gomez (Pediatrician)

Situation

Immediate clinical concern & reason for calling right now

• Nurse Amanda, RN (Pediatric Inpatient Unit) calling Dr. Gomez (On-Call Pediatric Hospitalist). • Patient: Lucas Morales (4yo M, Weight: 16.0 kg) in Room 204. • Immediate Concern: Acute respiratory distress with severe subcostal/intercostal retractions, grunting, and oxygen desaturation to 89% on 2L nasal cannula following second DuoNeb treatment 15 minutes ago.

Background

Relevant clinical history, admitting diagnosis, medications & baseline

• Admitted 6 hours ago with viral Bronchiolitis / Reactive Airway Disease exacerbation. • History: Full-term birth, mild recurrent wheezing with viral URIs, no prior intubations. • Current Meds: Albuterol 2.5mg/Ipratropium 0.5mg nebulizer Q3H, Oral Prednisolone 1 mg/kg (16mg given at 14:00). • Access: 22G peripheral IV right hand, infusing D5 1/2NS + 20 mEq KCl @ 52 mL/hr (standard maintenance rate for 16 kg). • Allergies: Amoxicillin (Rash). Immunizations: Up to date. Parents present at bedside.

Assessment

Current vital signs, objective physical findings & clinical interpretation

• Pediatric Assessment Triangle (PAT): - Appearance: Lethargic, irritable, consolable only briefly by mother, weak cry. - Work of Breathing: Marked tachypnea (RR 52/min), nasal flaring, prominent suprasternal & intercostal retractions, audible expiratory wheezes bilaterally with diminished air entry at bases. - Circulation to Skin: Pale, capillary refill 3 seconds, peripheral pulses palpable. • Vitals: BP 96/60, HR 158 (sinus tach), RR 52, SpO2 89% on 2L NC, Temp 38.6°C (101.5°F). Weight: 16.0 kg.

Recommendation / Request

Specific clinical action needed, timeframe & read-back confirmation

• I recommend you come evaluate the child at bedside immediately (within 10 minutes). • I request orders for: 1. Transitioning to High-Flow Nasal Cannula (HFNC) @ 2 L/kg/min (30 L/min) with FiO2 50%. 2. Starting Continuous Albuterol Nebulization @ 10 mg/hr. 3. IV Magnesium Sulfate 50 mg/kg (800 mg IV in 100 mL NS over 20 min). 4. Evaluating criteria for Pediatric Intensive Care Unit (PICU) step-up transfer.

Looking for pediatric respiratory and status asthmaticus communication examples?Explore Pediatric Asthma Example on SBAR Examples →

Blank Pediatric SBAR Layout

Patient / Age: _______________

Exact Weight: _______ kg

Parents Present: Yes / No

Immunizations: UTD / Delayed

IV Maintenance Rate: ___ mL/hr

Hydration / Wet Diapers: ______

Allergies: ___________________

Code Status: Full Code

[S] SITUATION (Pediatric):Acute change, child's age & weight, reason calling doctor...

[B] BACKGROUND (Pediatric):Birth history, viral exposure, recent nebulizers/steroids, oral intake tolerance...

[A] ASSESSMENT (Pediatric Assessment Triangle + Vitals):Appearance (tone/cry), Work of Breathing (retractions/flaring), Skin (mottling/cap refill), Vitals...

[R] RECOMMENDATION (Pediatric):High-flow O2/HFNC, weight-based med orders (mg/kg), PICU evaluation, read-back verified...

Authoritative Pediatric References:

1. American Academy of Pediatrics (AAP). Pediatric Advanced Life Support (PALS) & Clinical Handoff Communication Guidelines.

2. Society of Pediatric Nurses (SPN). Standardized Communication Tools for Pediatric Hospitalized Children.

Clinical Communication Notice

Medical Disclaimer: This Pediatric SBAR template is an educational communication tool and does not substitute for licensed pediatric clinical assessment, PALS algorithms, or hospital weight-based medication double-check policies.

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