NICE Traffic Light System for Fever in Under 5s

Assess a feverish child under 5 with the NICE traffic light system.

By Dr Amer Sheikh, GP Updated 17 October 2026 Clinical review pending

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How the traffic light system works

Colour	Risk	Action
Green	Low risk	Usually home care with safety-netting advice
Amber	Intermediate risk	Safety net or refer for paediatric assessment
Red	High risk	Urgent face-to-face paediatric assessment; 999 if life-threatening

Examples of red features

Pale, mottled, ashen or blue
No response to social cues, or appears ill
Grunting, respiratory rate over 60, or moderate to severe chest indrawing
Reduced skin turgor
Age under 3 months with temperature 38°C or more
Non-blanching rash, bulging fontanelle, neck stiffness or seizures

Frequently asked questions

What is the NICE traffic light system?

A tool from NICE NG143 that grades risk of serious illness in feverish children under 5.

What should I do with an amber child?

Either give a clear safety net with follow-up, or refer for paediatric assessment.

Is fever under 3 months a red flag?

Yes. A temperature of 38°C or more under 3 months is a red feature.

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References

NICE. Fever in under 5s: assessment and initial management. NG143. nice.org.uk/guidance/ng143

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