PALS stands for Pediatric Advanced Life Support. It is a set of guidelines and a training course developed by the American Heart Association (AHA) that teaches healthcare providers how to recognize and treat life-threatening emergencies in infants and children. The course covers everything from cardiac arrest to severe breathing problems, giving medical teams a structured, step-by-step approach to stabilizing a critically ill child.
What PALS Covers
Children are not small adults. Their hearts beat at different rates, their blood pressure ranges vary dramatically by age, and the most common reasons they go into cardiac arrest differ from adults. PALS exists because pediatric emergencies require their own playbook. The course trains providers to systematically assess a child, identify the type of emergency, and follow specific algorithms (decision trees) for treatment.
The core skills taught in PALS include high-quality CPR tailored to pediatric patients, recognizing abnormal heart rhythms, managing a child’s airway, and using the right medications at weight-based doses. The AHA updated PALS most recently in 2025 to reflect the latest evidence on what improves survival in children.
Who Needs PALS Certification
PALS is designed for healthcare professionals who may encounter pediatric emergencies. That includes emergency department doctors and nurses, paramedics, pediatric intensive care staff, anesthesiologists, respiratory therapists, and anyone working in a setting where critically ill children might arrive. Many hospitals and emergency medical services require PALS certification as a condition of employment for these roles.
After completing the course, providers receive a certification card valid for two years. Recertification involves taking an updated course to stay current with any guideline changes.
How Pediatric CPR Differs From Adult CPR
One of the biggest differences PALS emphasizes is the compression-to-ventilation ratio during CPR. For adults, the standard is 30 compressions followed by 2 breaths regardless of how many rescuers are present. For children, the ratio can shift to 15 compressions and 2 breaths when two trained rescuers are working together, though 30:2 is also used. Large studies of children who went into cardiac arrest outside a hospital found that CPR combining compressions with ventilation (at either ratio) produced better outcomes than chest compressions alone. This matters because children’s cardiac arrests are more often caused by breathing failure than by a primary heart problem, making ventilation especially important.
The AHA’s guidelines also stress the physical mechanics of high-quality CPR in children: compressing the chest at the right depth and rate, minimizing pauses between compressions, allowing the chest to fully recoil after each push, and providing enough breaths without over-ventilating.
Cardiac Arrest Algorithms
When a child goes into cardiac arrest, PALS divides the response into two pathways based on the heart’s electrical activity. If a monitor shows a “shockable” rhythm, meaning the heart is quivering chaotically rather than pumping, rapid defibrillation (delivering an electrical shock) is the top priority. If defibrillation isn’t immediately available, epinephrine is given while the team prepares the defibrillator.
If the rhythm is “non-shockable,” meaning the heart has either flatlined or is producing disorganized electrical activity that won’t respond to a shock, the priority shifts to giving epinephrine as quickly as possible alongside continuous CPR. Research consistently shows that early epinephrine in these cases is associated with better outcomes for infants and children.
Getting Emergency Access in Small Patients
One of the practical challenges in pediatric emergencies is that children’s veins are small and can be extremely difficult to access, especially when a child is in shock and blood vessels have constricted. PALS teaches providers to use intraosseous (IO) access, a technique where a needle is inserted directly into the bone marrow, typically in the shin bone just below the knee. Bone marrow connects to the bloodstream, so medications and fluids delivered this way reach the heart almost as fast as through a vein.
IO access is recommended whenever standard IV access fails or would take longer than about 90 seconds to establish. Alternative sites include the lower shin bone near the ankle, the thigh bone above the kneecap, and the upper arm bone in older children. This technique is a critical backup that PALS providers are trained to perform confidently.
Why Pediatric Vital Signs Matter in PALS
Recognizing a problem early is half the battle in pediatric emergencies, and that requires knowing what “normal” looks like at each age. A newborn’s resting heart rate can be as high as 170 beats per minute while awake, which would signal a serious problem in a teenager. By adolescence, a normal heart rate drops to roughly 55 to 90 beats per minute.
Blood pressure follows a similar pattern. An infant’s normal systolic blood pressure (the top number) ranges from about 72 to 104 mmHg, while a healthy adolescent typically reads between 102 and 124 mmHg. A blood pressure reading that looks perfectly normal for a 13-year-old could actually indicate dangerously high pressure in a 6-month-old, or vice versa. PALS training drills these age-specific ranges so providers can spot warning signs before a child deteriorates into cardiac arrest.
During active CPR, the 2025 guidelines now include specific blood pressure targets for children who already have an arterial monitor in place: providers aim for a diastolic pressure (the bottom number) of at least 25 mmHg in infants and at least 30 mmHg in children one year and older. These targets help teams gauge whether their chest compressions are generating enough blood flow to vital organs.
PALS vs. BLS and ACLS
PALS is one of three major resuscitation courses offered by the AHA. Basic Life Support (BLS) covers foundational CPR and choking response for all ages and is a prerequisite for most healthcare workers. Advanced Cardiovascular Life Support (ACLS) focuses on adult cardiac emergencies. PALS fills the pediatric gap, addressing the unique anatomy, physiology, and common emergency scenarios specific to infants and children.
All three courses share the same underlying principle: structured, evidence-based algorithms that reduce hesitation during a crisis. But PALS adds layers of complexity around weight-based medication dosing, age-specific vital sign interpretation, and the reality that children often arrest from respiratory causes rather than the primary heart rhythm problems more common in adults. For any healthcare provider who might treat a critically ill child, PALS certification is considered essential preparation.