Pediatric emergency medicine in Lebanon: Physician-perceived comfort levels, challenges, and educational needs

BACKGROUND: Pediatric Emergency Medicine (PEM) is a rapidly evolving subspecialty that improves the quality and safety of care for children. Despite global advancements, PEM remains underdeveloped in many low- and middle-income countries, including Lebanon. Despite a large pediatric population there is no formal paediatric emergency medicine system in place, and care largely delivered by physicians practicing without standardized or specialized training. This lack of dedicated PEM training and organized emergency care pathways may compromise the timely recognition and management of pediatric emergencies, potentially affecting patient outcomes. OBJECTIVES: The present study aimed to assess physicians perceived comfort in managing pediatric emergencies, identify training gaps, and explore systemic and institutional challenges affecting pediatric emergency care in Lebanon. METHODS: A descriptive cross-sectional survey was conducted among physicians involved in pediatric emergency care across Lebanon. The questionnaire assessed self-reported comfort in managing pediatric emergencies, perceived challenges, and priorities for training and PEM workforce development. RESULTS: Responses from 59 physicians were analysed. Most were male 38 (64.4%), with a median clinical experience of 7 years. General pediatricians represented 28 (47.5%), emergency physicians 17 (28.8%), PEM specialists 8 (13.6%), and pediatric intensivists 6 (10.2%). Physicians reported high perceived comfort in pediatric fluid management 52(88.1%), chest X-ray interpretation 46 (77.9%), and general pediatric emergencies 42 (71.2%), but lower comfort in procedural sedation, suturing 35 (59.6%), fracture stabilization 35 (59.4%), and Extended Focused Assessment Sonography in Trauma (EFAST) 22 (41.8%). General pediatricians reported greater comfort with general pediatric emergencies, while emergency-focused physicians had higher comfort with trauma-related skills and procedural interventions. Major challenges included gaps in practical and theoretical training, limited hospital infrastructure, shortages of devices and human resources, and the need for continuing medical education. Nearly all participants 57 (96.6%) supported the establishing a dedicated PEM fellowship, highlighting training priorities in trauma, medical emergencies, life support, procedural skills, and pediatric imaging. CONCLUSION: Pediatric emergency care in Lebanon is constrained by gaps in skills, training, and systemic resources. There is an urgent need to establish standardized PEM training pathways, enhance curricula, and strengthen system-level preparedness. Implementing these measures will support a competent PEM workforce and improve the quality and safety of emergency care for children nationwide.