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Under 5 with a fever stratify according to traffic light colour - ¨until clinical diagnosis of underlying condition¨

Must record - ''temp, heart rate, resp rate and cap refill''
temp - electronic in axilla (or chemical dot in axilla if >4/52), or infra-red tympanic
Also look for signs of dehydration (reduced skin turgor, cool extremities etc) 


||''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 bpm 6-12/12, >40 bpm >12/12, Oxygen saturation <=95%(air), Crackles in the chest|Grunting, Tachypnoea: respiratory rate >60 bpm, Moderate or severe chest indrawing|
|Circulation and hydration|Normal skin and eyes, Moist mucous membranes|Tachycardia: >160 bpm <12/12, >150 bpm 12-24/12, >140 bpm 2-5y, Cap refill >=3secs, Dry mucous membranes,  Poor feeding in infants, Reduced urine output|Reduced skin turgor|
|Other|No amber or red signs|3-6/12 temp >=39ºC, Fever >=5 days, Rigors, Swelling limb/joint, Non-weight bearing limb/not using an extremity|<3/12 temp >=38°C, Non-blanching rash, Bulging fontanelle, Neck stiffness, Status epilepticus, Focal neuro or seizures|

''Management''
Green - at home with advice including when to get further help
Amber - safety net or refer to paed 
Red - refer child urgently to paeds

''Safety net''
verbal or written information including
warning symptoms, how to access more care, FUp appt,  liaise with other healthcare professionals, e.g. OOH

''Note''
Don´t give oral Abs unless source identified    oral antibiotics should not be prescribed to children with fever without apparent source
 If suspect pneumonia but not refering - no need for CXR unless other indication 
anti-pyretics if distressed