Core framework: traffic light risk assessment
NICE recommends using a traffic light system to stratify serious illness risk in under-5s (green/amber/red). Management urgency follows the highest-risk feature present.
- Red features: treat as high risk and arrange urgent assessment.
- Amber features: intermediate risk — face-to-face assessment and “safety net” if no clear diagnosis.
- Green features: low risk — home care advice + safety netting.
High-risk patterns (examples to remember)
- Non-blanching rash with fever: consider meningococcal disease, especially with purpura (>2 mm lesions), cap refill ≥3 seconds, or neck stiffness.
- Age <3 months: temperature ≥38°C is a red flag; age 3–6 months with temp ≥39°C is amber.
- Seizures: status epilepticus or focal seizures increase risk category and urgency.
- Dehydration signals: prolonged cap refill, dry mucous membranes, reduced urine, poor feeding (often amber).
Disposition and safety netting (NICE)
- Life-threatening features: immediate emergency referral (usually 999).
- Any red (but not life-threatening): urgent face-to-face assessment within 2 hours and/or urgent paediatric specialist review.
- Amber without red: face-to-face assessment; if no diagnosis, provide “safety net” (written/verbals, clear re-access route) or refer for specialist assessment.
- Home advice should include: checking during the night, hydration advice, how to recognise a non-blanching rash, and to seek help if a fit occurs, rash develops, child deteriorates, or fever lasts ≥5 days.
Frequently asked questions
What is the most useful one-liner for parents?
“If your child looks worse, has a fit, develops a non-blanching rash, or the fever lasts 5 days, seek urgent medical advice.”
Should a non-paediatric clinician use the same approach?
Yes. NICE specifically includes primary care clinicians in the “non-paediatric practitioner” pathway and recommends the traffic light system plus clear safety-netting.
Do all febrile children need tests?
No. Testing depends on risk category and clinical picture. Use the traffic light stratification and clinical assessment to decide investigations and escalation.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.