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Why did you do this work?Physiological observation monitoring is a key aspect of care in children and young people (CYPs) admitted for medical stabilisation of eating disorders (EDs) to assess severity of illness and plan care accordingly. Nottingham Children’s Hospital (NCH) utilises a local paediatric early warning system (PEWS) with a special circumstance module designed for CYPs with EDs to account for physiological abnormalities associated with the condition. PEWS is set to be replaced by a national paediatric early warning system (NPEWS) standardised across hospitals.What did you do?Our Aim to assess the impact of introducing NPEWS on our current patterns of trigger and escalation of paediatric care for CYPs with restrictive EDs currently monitored under local PEWS. This study consists of a retrospective clinical audit on CYPs admitted to NCH with restrictive EDs. Inclusion criteria CYPs aged 12–18 years old with restrictive ED diagnoses (including anorexia nervosa, atypical anorexia and ARFID), admitted to NCH between 2019 and 2022 whose admission duration exceeded 1 day. The highest local PEWS scores during the first week of admission were obtained and NPEWS calculated from the same set of observations data.What did you find?There is correlation between the highest local PEWS and NPEWS scores (r2 = 0.665) and limits of agreement on a Bland Altman plot of -2.5 to +3 (95% CI). The change in scoring rubric between local PEWS and NPEWS resulted in more NPEWS scores in the 1–4 range and 9–12 ranges and fewer NPEWS scores in the 5–8 range. When comparing the escalations triggered by local PEWS and NPEWS scores, there was a significant increase in overall escalations triggered 21/70 vs 70/70 using Fisher’s exact test (two-tailed P value < 0.0001) and a greater proportion of urgent and immediate reviews seen with NPEWS x 2 (1, N=70) = 20.8 p<.00001.What does it meanNPEWS results in an increased number of triggers and an overall increase in the level of escalation of paediatric care in CYPs admitted with restrictive EDs when compared to local PEWS. NPEWS requires a special circumstances consideration to account for the physiological difference in CYPs with EDs in order to prevent over-escalation of medical care.