The 2007 NICE Feverish illness in children guidelines introduced a 'traffic light' system for risk stratification of children under the age of 5 years presenting with a fever. These guidelines were later modified in a 2013 update.
It should be noted that these guidelines only apply 'until a clinical diagnosis of the underlying condition has been made'. A link to the guidelines is provided but some key points are listed below.
The following should be recorded in all febrile children:
Signs of dehydration (reduced skin turgor, cool extremities etc) should also be looked for
Measuring temperature should be done with an electronic thermometer in the axilla if the child is < 4 weeks or with an electronic/chemical dot thermometer in the axilla or an infra-red tympanic thermometer.
Please see the link for the complete table, below is a modified version
| Green - low risk | Amber - intermediate risk | Red - high risk | |
|---|---|---|---|
| Colour | • 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/minute, age >12 months | |||
| • 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: | ||
| • >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 | ||
| Other | No amber or red signs | • Age 3-6 months, temperature >=39ºC | |
| • 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 |
If green:
If amber: