Paediatric Levels of Care

Infants, children and youth have unique healthcare needs compared to adults; a range of paediatric expertise and resources is essential in hospitals to ensure that paediatric inpatients receive appropriate, safe and quality care throughout the continuum of inpatient care.

PCMCH developed three distinct paediatric levels of inpatient care that take into consideration the acuity of the presenting complaint; the medical complexity of the patient’s underlying condition; and/or the complexity of the surgery or procedure required. The goal is to ensure that quality services are provided to paediatric patients and their families as close to home as possible, in the right place, at the right time, and by the right provider(s).  Additionally, the levels will:

  • Help provide a clear, consistent, and transparent understanding of services provided at any given hospital site;
  • Enable healthcare professionals to know where to call for advice and consultation;
  • Support the flow of patients to both higher and lower levels of care, including repatriation;
  • Foster shared-care management of patients when appropriate;
  • Facilitate dialogue that identifies gaps and opportunities for capacity building, quality initiatives, system improvements, etc. at the organizational, regional and provincial levels; and
  • Enable a seamless system of care across the maternal-newborn-paediatric continuum.

In October 2018, all Ontario hospitals were asked to complete an organizational self-assessment survey regarding mandatory and highly recommended criteria for the paediatric inpatient services they could provide within current resources. This process was not about increasing or decreasing capacity; rather, it was about standardization and acknowledging the services that hospitals are able to provide. A PLC designation was then assigned to hospitals in which inpatient care is provided to paediatric patients.

The PLC definitions and hospital designations, along with background information on the initiative, are available in the Paediatric Levels of Care Summary Report (June 2021).

Hospitals are encouraged to engage in discussions within their regions, with their respective Ontario Health regions and with their Maternal-Newborn-Child Health Regional Networks to discuss their PLC self-assessment results and to identify priority areas for collaboration.

Effective collaboration at the regional level will enhance access and help facilitate patient flow and movement to the right level of care (higher and, in some instances, lower).

Please send any questions about this initiative to

In 2023, Critical Care Services Ontario (CCSO) released the Paediatric Levels of Care Guidance document to describe the criteria and capabilities of Level 2 and Level 3 Paediatric Intensive Care Units (PICUs) in Ontario at the unit level. The purpose of this document is to serve as a guidance for both level 2 and level 3 PICUs currently operating, as well as those in the planning phase of developing new PICUs. Please visit CCSO’s website to access the PICU Levels of Care Guidance Document.