Table 1.

Symptoms and signs indicating low, intermediate and high risk for serious illness [21] (Evidence A).

	Low risk	Intermediate risk	High risk
Age		•Age 3–6 months with temperature ≥ 39 °C	•Age < 3 months with temperature ≥ 38 °C
Colour	•Normal colour of skin, lips and tongue	•Pallor of skin, lips or tongue reported by parent or carer	•Pale/mottled/ashen/blue skin, lips or tongue
Activity	•Responds normally to social cues •Content/smiles •Stays awake or awakens quickly •Strong normal cry or not crying	•Not responding normally to social cues •No smile •Wakes only with prolonged stimulation •Decreased activity •Poor feeding in infants	•No response to social cues •Appearing ill to a healthcare professional •Does not wake or if roused does not stay awake •Weak, high-pitched or continuous cry
Respiratory		•Nasal flaring •Respiratory rate >50 breaths/min (age 1–12 months) or >40 breaths/min (age > 12 months) •O2 saturation ≤ 95% in air •Crackles in chest	•Grunting •Respiratory rate >60 breaths per minute •Moderate or severe chest indrawing
Circulation and hydration	•Normal skin and eyes •Moist mucous membranes •Passing urine adequately	•Heart rate >160 beats/min (age < 12 months) or >150 beats/min (age 12–24 months) or >140 beats/min (age 2–5 years) •Capillary refill time ≥ 3 s •Dry mucous membranes •Reduced urine output	•Reduced skin turgor
Other	•No intermediate or high risk factors present	•Fever >5 days •Rigors •Swelling of a joint or limb •Non-weight bearing limb or not using an extremity	•Non-blanching rash •Bulging fontanelle •Neck stiffness •Status epilepticus •Focal neurological signs •Focal seizures

Adapted with permission from ©NICE (2019). NG143 Fever in under 5 s: assessment and initial management. Available from http://www.nice.org.uk/guidance/ng143. All rights reserved. Subject to Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this publication.