NICE traffic light system

Traffic light system for identifying risk of serious illness in children aged less than five with a fever and the summary of symptoms and signs suggestive of specific diseases.

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:
    • - RR >50 breaths/minute, age 6-12 months - RR >40 breaths/ minute, age >12 months
  • Oxygen saturation ≤95% in air
  • Crackles in the chest
  • Grunting
  • Tachypnoea: RR >60 breaths/minute
  • Moderate or severe chest indrawing
Circulation and hydration
  • Normal skin and eyes
  • Moist mucous membranes
  • Tachycardia:
    • - >160 beats/minute, age <12 months
    • - >150 beats/minute, age 12-24 months
    • - >140 beats/minute, age 2-5 years
  • CRT ≥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°C
  • Fever for ≥5 days
  • Rigors
  • Swelling of a limb or joint
  • Non-weight bearing limp/not using an extremity
  • Age <3 months, temperature ≥38°C
  • Non-blanching rash
  • Bulging fontanelle
  • Neck stiffness
  • Status epilepticus
  • Focal neurological signs
  • Focal seizures
CRT, capillary refill time; RR, respiratory rate

Reference: ‘Feverish illness in children’, NICE clinical guideline 160 (May 2013)