POCUS for the general pediatrician: a narrative review of practical applications, policy, and training

Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable bedside imaging modality in pediatric medicine, enabling rapid real-time patient assessment and procedural guidance. While its use is well established in pediatric emergency and critical care settings, its role in general pediatric practice is expanding. This narrative review summarizes the practical applications of POCUS relevant to general pediatricians, focusing on lung imaging, focused functional cardiac assessment, ultrasound-guided vascular access, and the image governance required for safe implementation. A narrative review of contemporary pediatric literature and relevant consensus guidance was undertaken, focusing on evidence applicable to general pediatric practice, including diagnostic performance, procedural utility, education, and governance. Evidence supports the use of POCUS in general pediatrics as a means to improve diagnostic confidence and procedural outcomes. Lung ultrasound demonstrates high diagnostic accuracy for common pediatric respiratory conditions, including consolidation and pleural effusion, and may reduce reliance on chest radiography. Focused cardiac ultrasound provides actionable insights into fluid responsiveness and ventricular function at the bedside, facilitating timely decision-making and early identification of cardiogenic shock. Ultrasound-guided vascular access improves cannulation success rates and reduces complication risks, especially in children with difficult access. Despite these benefits, the adoption of POCUS in general pediatrics remains uneven across Europe, primarily due to variability in training standards, credentialing processes, and institutional support.

POCUS has the potential to enhance bedside pediatric assessment by improving diagnostic confidence, procedural safety, and responsiveness to clinical change. Safe and equitable integration into general pediatric practice will require structured training, clear governance, routine image archiving, and a coordinated approach to competency and implementation.

• POCUS supports bedside assessment and procedural success in pediatric emergency and critical care. • Lung, focused cardiac and ultrasound-guided vascular access may also benefit general pediatric practice.

• This review defines a pragmatic core POCUS scope for general pediatricians. • It links that scope to image governance and an author-proposed tiered competency framework for European implementation.