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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

Authoring team

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


Responds normally to social cues


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


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


Tachypnoea: respiratory rate >60 breaths/minute

Moderate or severe chest indrawing

Circulation and hydration

Normal skin and eyes

Moist mucous membranes


  • >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


None of the amber or red symptoms or signs

Age 3-6 months, temperature >= 39 deg C

Fever for >=5 days


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


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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.


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