Nice Traffic light system for identifying risk of serious illness in under 5s

	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 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 with temperature ≥39°C; Fever for ≥ 5 days; Rigors; Swelling of a limb or joint; Non-weight bearing limb/not using an extremity”	Age < 3 months with temperature > 38°C; Non-blanching rash; Bulging fontanelle; Neck stiffness; Status epilepticus; Focal neurological signs; Focal seizures

The traffic light system is also available in colour on the NICE website.

This traffic light table should be used in conjunction with the recommendations in this guideline on investigations and initial management in children with fever.