The critically unwell child

Abstract Critically unwell children present many unique management challenges. Anatomical and physiological differences between children and adults, including their ability to compensate during periods of physiological derangement, make assessment difficult and can result in rapid decompensation if not fully appreciated. The post-operative surgical child is hypermetabolic—a state which tends to promote healing. Excessive or inadequate hypermetabolic responses may result in a prolonged and maladaptive systemic inflammatory response syndrome, which, if not reversed, leads to multiorgan failure. Surgery is increasingly being offered to children with complex pre-existing morbidities, many of whom require a period of intensive care. A brief overview of recognizing the unwell child, intravenous fluid administration, transfusion, inter-hospital transport, and extracorporeal membrane oxygenation is presented.