Log in 

“Traffic light system” to predict risk of serious illness in children with fever.Return to article.

CLINICAL CONDITION	Low risk	Intermediate risk	High risk
Skin appearance	Normal colour of skin, lips and tongue	Pallor reported by parent/carer	Pale, mottled, ashen, blue
Responsiveness	Responds normally to social cues Content/smiles Stays awake or awakens quickly Strong normal cry or not crying	Not responding normally to social cues Wakes only with prolonged stimulation Decreased activity No smile	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	Normal	Nasal flaring Tachypnoea: 6–12 months RR > 50 breaths/minute >12 months RR > 40 breaths/minute Oxygen saturation ≤ 95% in air Crackles/chest signs	Grunting Tachypnoea: RR > 60 breaths/minute Moderate or severe chest indrawing
Hydration	Normal skin and eyes Moist mucous membranes	Dry mucous membranes Poor feeding in infants Capillary refill time (CRT) ≥ 3 seconds Reduced urine output	Reduced skin turgor
Other	None of the amber or red symptoms or signs	Fever for ≥ 5 days Swelling of a limb or joint Non-weight bearing, not using an extremity A new lump > 2 cm None of the red symptoms or signs	Age 0 – 3 months, temperature ≥ 38°C Age 3 – 6 months, temperature ≥ 39°C Non-blanching rash Bulging fontanelle Neck stiffness Status epilepticus Focal neurological signs Focal seizures Bile-stained vomiting
ACTION	Reassure	Review	Refer