Risk stratification

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 Pale/mottled/ashen/blue

parent/carer

Activity Responds Not responding normally to No response to social cues

normally to social social cues Appears ill to a healthcare
cues No smile professional
Content/smiles Wakes only with prolonged Does not wake or if roused
Stays awake or stimulation does not stay awake
awakens quickly Decreased activity Weak, high-pitched or
Strong normal continuous cry
cry/not crying

Respiratory Nasal flaring Grunting

Tachypnoea: respiratory Tachypnoea: respiratory
rate rate >60 breaths/minute
Moderate or severe chest
indrawing
>50 breaths/minute,
age 6-12 months;
>40 breaths/minute,
age >12 months

Oxygen saturation <=95%

in air
Crackles in the chest

Circulation Normal skin and Tachycardia: Reduced skin turgor

and hydration eyes
Moist mucous
membranes >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
 Green - low risk Amber - intermediate risk Red - high risk

Other No amber or red Age 3-6 months,
signs temperature >=39C
Fever for >=5 days
Rigors
Swelling of a limb or joint
Non-weight bearing
limb/not using an extremity
Age <3 months, temperature
>=38C
Non-blanching rash
Bulging fontanelle
Neck stiffness
Status epilepticus
Focal neurological signs
Focal seizures

Management

If green:

Child can be managed at home with appropriate care advice, including when to seek further
help

If amber:

provide parents with a safety net or refer to a paediatric specialist for further assessment
a safety net includes verbal or written information on warning symptoms and how further
healthcare can be accessed, a follow-up appointment, liaison with other healthcare
professionals, e.g. out-of-hours providers, for further follow-up

If red:

refer child urgently to a paediatric specialist

Other key points include

oral antibiotics should not be prescribed to children with fever without apparent source
if a pneumonia is suspected but the child is not going to be referred to hospital then a chest
x-ray does not need to be routinely performed