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

Green – low riskAmber – intermediate riskRed – high risk
Colour (of skin lips or tongue)Normal colourPallor reported by parent/carerPale/mottled/ashen/blue
ActivityResponds normally to social cues,Content/smiles, Stays awake or awakens quickly, Strong normal cry/not cryingNot responding normally to social cues; No smile; Wakes only with prolonged stimulation;Decreased activityNo 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
RespiratoryNasal 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 chestGrunting; Tachypnoea: respiratory rate >60 breaths/minute; Moderate or severe chest indrawing
Circulation and hydrationNormal skin and eyes; Moist mucous membranesTachycardia: >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 outputReduced skin turgor
OtherNone of the amber or red symptoms or signsAge 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.