Mortality rates for children in the pediatric intensive care unit (PICU) have decreased 5-fold from 1-in-5 [1] to 1-in-25 [2] cases over the past few decades. Despite improvements in rates of survival after critical illness, 1-in-5 children who require life support in the PICU for an acute illness has a new morbidity up to 3 years after discharge.[2,3] That translates to new functional, cognitive, and/or neurological morbidity in 5–10% of PICU survivors.[2,3] Also, for the parents of these children, the child’s critical illness may become a chronic condition that leads to ongoing emotional stress for the whole family with significant psychological and social impact.[4]

There are several important distinctions between children and adults in regard to making a prognosis as a result of acute neurological injury – henceforth called neuroprognostication. Foremost, during the initial presentation of acute neurological illness, event, or trauma, there is a partnership between clinicians and parents, and the communication of likelihood of possible death versus survival.