Septic Shock in Children: Recognition and the First Hour

Sepsis remains one of the leading causes of death in children worldwide, and outcomes depend heavily on the first hour. Septic shock is covered as part of distributive shock on the PALS course.

Recognition

Suspect septic shock in a child with suspected infection plus signs of poor perfusion: fast heart rate, prolonged capillary refill or flash refill, cold or warm peripheries, altered mental state or low urine output. Blood pressure may remain normal until late — see compensated vs hypotensive shock.

The first hour

1. Oxygen and monitoring.
2. IV or IO access.
3. Fluid boluses of 10 to 20 mL/kg of isotonic crystalloid, reassessing after each for improved perfusion and for signs of fluid overload — see fluid resuscitation.
4. Antibiotics as soon as possible, after cultures if they do not delay treatment.
5. Check glucose and calcium and correct abnormalities.
6. If shock persists after fluids, start a vasoactive infusion such as adrenaline or noradrenaline, with expert help.

Watching for fluid overload

Crackles, an enlarging liver or worsening breathing mean further fluid may harm; stop and reassess.

Escalation

Early discussion with paediatric intensive care. See PALS for NICU and PICU teams and PALS for emergency departments.

This guide summarises what the PALS course teaches, for education only. It is not a clinical protocol: follow the current American Heart Association guidelines, linked below, and your institution’s paediatric policies.

More PALS guides: PALS assessment, algorithms and skills

• PALS Course in Abu Dhabi — dates, format and booking
• The PALS Systematic Approach: Assess, Categorise and Treat a Sick Child
• Respiratory Distress vs Respiratory Failure in Children
• Upper Airway Obstruction in Children: Croup, Foreign Bodies and Anaphylaxis
• Lower Airway Obstruction in Children: Asthma and Bronchiolitis
• Lung Tissue Disease and Disordered Control of Breathing in PALS
• Shock in Children: The Four Types Taught in PALS
• Fluid Resuscitation in Children: Boluses and Reassessment
• PALS Bradycardia Algorithm: Oxygen First, Then CPR and Drugs
• PALS Tachycardia: Sinus Tachycardia vs SVT in Children
• PALS Cardiac Arrest Algorithm: Shockable and Non-Shockable Rhythms
• PALS Post-Cardiac Arrest Care: After ROSC in Children
• PALS Drugs: Adrenaline, Adenosine, Amiodarone, Atropine and More
• Weight-Based Dosing in PALS: Estimating Weight and Avoiding Errors
• Intraosseous (IO) Access in PALS: When and How It Is Used
• Paediatric Vital Signs by Age: Heart Rate, Breathing and Blood Pressure
• PALS Defibrillation and Cardioversion: Energies per Kilogram
• All PALS guides, by topic

Other life support and first aid courses: BLS Course · ACLS Course · First Aid Course · Training calendar

Frequently asked questions

What are the signs of septic shock in a child?

Suspected infection with fast heart rate, poor perfusion, altered mental state or low urine output.

How much fluid is given in paediatric septic shock?

Boluses of 10 to 20 mL/kg with reassessment after each, as taught in PALS.

When are antibiotics given?

As soon as possible.

What if shock persists after fluids?

A vasoactive infusion is started, with expert help.

Can blood pressure be normal in septic shock?

Yes, in compensated shock.

Sources and further reading

What we teach follows the awarding body and the UAE health authorities. For the definitive position on a course or licensing question, these are the places to check.

• CPR and ECC Guidelines — American Heart Association
• PALS course options — American Heart Association

Last reviewed 21 September 2026 by the training team at Safety First Medical Services, an American Heart Association training centre at Addax Office Tower, Al Reem Island, Abu Dhabi. Call +971 55 761 9841 or email training@safetyfirstmed.ae.