Abstract: This Audit was initiated to assess the current use of the Paediatric Early Warning Scores (PEWS) and its effectiveness in identifying at-risk paediatric patients within the Accident and Emergency department (A&E) of Sirimavo Bandaranayaka Specialized Children’s Hospital (SBSCH) Peradeniya. Objectives and Methods: To evaluate adherence to established PEWS protocols while ensuering correct PEWS calculation, prompt evaluation of charts, timely intervention and improve patient outcomes. Data collected from category-2 admissions to the A&E over 3 months with emphasis on .Patient demographics, Presenting complaint, PEWS initiation status, PEW Scores, timing of assessment and intervention, type of intervention. Results: Twenty which represented the entire audit population A substantial 35% 7/20 of eligiblepatients did not have a PEWS chart initiated PEWS Score Accuracy 76.9%, only 10 out of 13 completed. Average Delay from Presentation to PEWS Assessment was approximately 24 minutes (0 -112). Average Delay of Assessment to Intervention 24 minutes (5-100) Out of the 5 patients where PEWS was initiated 4 subsequently deteriorated. 3 out of 7 (43%) patients had clinical deterioration; PEWS not initiated. 2 out of 4 (50%) of them required intubation and ventilation. Conclusion: This audit highlights significant deficiencies in the current practice of PEWS chartMost critically , low compliance rate for PEWS initiation directly translates into missed opportunities for early identification of deteriorating paediatric patients.