traffic light system table for identifying risk of serious illness in child under 5 years with fever (feverish)
Last edited 12/2021 and last reviewed 12/2021
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
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:
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:
important conditions to be considered in a child with a fever