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Consensus statement on the use of standardized early mobilization in pediatric patients admitted to pediatric

Matteo Di Nardo1, Elisa Poletto2, Ezio Bonanomi3

  • 1Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. matteo.dinardo@opbg.net.

European Journal of Pediatrics
|July 3, 2026
PubMed

Insights

Early mobilization (EM) in pediatric intensive care units (PICUs) is crucial for preventing weakness. This consensus provides standardized guidelines for EM implementation across Italian PICUs, respecting local practices.

Area of Science:

  • Pediatric Intensive Care
  • Rehabilitation Medicine
  • Clinical Practice Guidelines

Background:

  • Prolonged immobility in the pediatric intensive care unit (PICU) is a significant factor contributing to PICU-acquired weakness, delirium, and post-intensive care syndrome (PICS).
  • Current adoption of early mobilization (EM) practices in Italian PICUs is low (15%) and highly variable.
  • Existing evidence supports the feasibility and potential benefits of EM in adult intensive care, with emerging data suggesting safety in pediatric populations, though further standardization is needed.

Purpose of the Study:

  • To develop consensus statements for standardizing early mobilization (EM) practices across Italian pediatric intensive care units (PICUs).
  • To create implementable guidelines that accommodate local variability in practices and equipment within Italian PICUs.
  • To promote consistent and effective EM interventions to improve functional recovery in pediatric patients.

Main Methods:

  • A multidisciplinary panel of 20 Italian PICU experts, including nurses and physiotherapists, was convened.
  • A comprehensive literature search (2010-July 2025) was conducted across PubMed, CINAHL, and PEDro.
  • Consensus statements were developed using a Quaker-based methodology and voted on via the RAND/UCLA appropriateness method.

Main Results:

  • From 8380 records, 113 studies were deemed eligible for review.
  • Twenty-two statements and four tables were drafted, with 20 statements and three tables achieving strong agreement in the first round.
  • The remaining two statements and one table were revised and achieved weak agreement, reflecting a consensus on core principles while acknowledging areas for further refinement.

Conclusions:

  • The developed consensus provides standardized and implementable statements to guide the adoption of early mobilization (EM) across Italian PICUs.
  • These guidelines aim to standardize EM while accommodating local practice differences and variability.
  • Future efforts should concentrate on the validation, implementation, and dissemination of these consensus statements to maximize their impact.

Keywords:
PICSPICU-acquired syndromePediatric early mobilizationPediatric rehabilitation

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