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Traffic light system table for identifying risk of serious illness in child under 5 years with fever (feverish)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Traffic light system for identifying risk of serious illness

children with fever and any of the symptoms or signs in the red column should be recognised as being at high risk
children with fever and any of the symptoms or signs in the amber column and none in the red column should be recognised as being at intermediate risk
children with symptoms and signs in the green column and none in the amber or red columns are at low risk

The management of children with fever should be directed by the level of risk. This traffic light table should be used in conjunction with the recommendations in this guideline on investigations and initial management in children with fever

	Green - low risk	Amber - intermediate risk	Red - high risk
Colour (of skin, lips or tongue)	Normal colour	Pallor reported by parent/carer	Pale/mottled/ashen/ blue
Activity	Responds normally to social cues Content/smiles Stays awake or awakens quickly Strong normal cry/ not crying	Not responding normally to social cues No smile Wakes only with prolonged stimulation Decreased activity	No response to social cues Appears ill to a healthcare professional Does not wake or if roused does not stay awake Weak, high-pitched or continuous cry
Respiratory		Nasal flaring Tachypnoea: respiratory rate >50 breaths/ minute, age 6-12 months; >40 breaths/ minute, age >12 months Oxygen saturation <=95% in air Crackles in the chest	Grunting Tachypnoea: respiratory rate >60 breaths/minute Moderate or severe chest indrawing
Circulation and hydration	Normal skin and eyes Moist mucous membranes	Tachycardia: >160 beats/ minute, age <12 months >150 beats/ minute, age 12-24 months >140 beats/ minute, age 2-5 years Capillary refill time >=3 seconds Dry mucous membranes Poor feeding in infants Reduced urine output	Reduced skin turgor
Other	None of the amber or red symptoms or signs	Age 3-6 months, temperature >= 39 deg C Fever for >=5 days Rigors Swelling of a limb or joint Non-weight bearing limb/ not using an extremity	Age <3 months, temperature >= 38 deg C Non-blanching rash Bulging fontanelle Neck stiffness Status epilepticus Focal neurological signs Focal seizures

recognise that children younger than 3 months with a temperature of 38°C or higher are in a high-risk group for serious illness
recognise that children aged 3-6 months with a temperature of 39°C or higher are in at least an intermediate-risk group for serious illness
do not use duration of fever to predict the likelihood of serious illness. However, children with a fever lasting 5 days or longer should be assessed for Kawasaki disease
think "Could this be sepsis?" and refer to the NICE guideline on sepsis: recognition, diagnosis and early management if a child presents with fever and symptoms or signs that indicate possible sepsis
- sepsis is a condition of life-threatening organ dysfunction due to a dysregulated host response to infection

Reference:

(1) NICE (November 2021). Feverish illness in children Assessment and initial management in children younger than 5 years

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Traffic light system table for identifying risk of serious illness in child under 5 years with fever (feverish)

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