Table 1

NICE traffic light system

Green—low riskAmber—intermediate riskRed—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/min (age >12 months)

  • Oxygen saturation ≤95% in air

  • Crackles in the chest

  • Grunting

  • Tachypnoea: respiratory rate >60 breaths/min

  • Moderate or severe chest indrawing

Circulation and hydration

  • Normal skin and eyes

  • Moist mucous membranes

  • Tachycardia: heart rate

    • >160 beats/min (age <12 months);

    • >150 beats/min (age 12–24 months);

    • >140 beats/min (age 2–5 years)

  • Capillary refill time ≥3 s

  • 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 limb/not using an extremity

  • Age <3 months, temperature ≥38°C

  • Non-blanching rash

  • Bulging fontanelle

  • Neck stiffness

  • Status epilepticus

  • Focal neurological signs

  • Focal seizures

  • Note that some vaccinations have been found to induce fever in children aged under 3 months.

  • NICE, National Institute for Health and Care Excellence.