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.