All about the NICE traffic light system for recognising serious illness in children

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The NICE traffic light system was first devised in 2007 and has been updated several times since. It serves the purpose of helping clinicians to identify how at risk a child is of serious illness having considered their symptoms.

What each one means:

Red (High Risk)

A child that could be categorised as ‘red’ will be exhibiting serious and life threatening symptoms requiring immediate emergency care.

These include:

  • Features of sepsis or central nervous system infection. This could be due to encephalitis or bacterial meningitis/meningococcal disease.
  • Features of severe dehydration or pneumonia. This may be a dry or mucus cough and/or chest pain, poor heart function or difficulty in breathing.
  • Being unresponsive/unconscious, confused or crying in high pitched, prolonged tones.
  • Skin which is pale, mottled or ashen

Amber (Intermediate Risk)

Amber type symptoms include:

  • Pallor, reported by the parent/carer
  • Not responding normally to social cues
  • Not smiling or engaging with those around them
  • Only waking when vigorously stimulated
  • Nasal flaring
  • Crackles in the chest or poor oxygen saturation
  • Poor feeding and reduce urine output
  • Tachycardia
  • Dry mucus membranes

If there are amber features (but no red ones), arrange a face-to-face assessment if the child or infant was initially assessed by telephone. This will then determine if hospital admission is required.

Hospital admission should be considered if:

  • The child is under 3 months and presenting with a suspected urinary tract infection (UTI) with no alternative focus of infection.
  • The feverish illness has no obvious underlying cause, and the child or infant is unwell for longer than you would expect a self-limiting illness to last.
  • There is significant parental/carer anxiety or they are struggling to cope due to the family/social situation.

If the child’s illness can be managed at home, provide safety netting advice to the parents/carers by one or more of the following methods, depending on clinical judgement:

  • Advise on warning signs and symptoms and make sure they understand if/when to call an ambulance.
  • Arrange a follow-up appointment in primary care so the child’s progress can be reviewed.
  • Liaise with other healthcare professionals, as well as out-of-hours providers, to ensure direct access for the child if additional assessment is needed.

Green (Low Risk)

If there are green features (but no amber or red ones), the child can normally be managed at home. However, be aware of the possibility of Kawasaki disease in children with fever that has lasted longer than 5 days.

Other symptoms of Kawasaki disease may include:

  • Erythema and cracking of lips; strawberry tongue; or erythema of oral and pharyngeal mucosa.
  • Cervical lymphadenopathy.
  • Bilateral conjunctival injection without exudate.
  • Polymorphous rash.
  • Oedema and erythema in the feet and hands.More about the specifics of the NICE traffic light system can be found here.

Learn how to identify the risk of children becoming very seriously ill with our scheduled webinar courses this July

Can you accurately assess the risk of serious illness in a child using the NICE traffic light system? Do you feel able to confidently support anxious parents/carers?

Designed specifically for nurses and other front line allied health professionals, PDUK now offers a handy webinar on this subject.

Perfect for any healthcare professionals who are looking for a flexible, highly interactive way of learning, PDUK webinars are a great way of keeping your skills current. They’re ideal too for those of us looking to study from home during the COVID-19 outbreak, as they’re a socially distanced way of learning safely.

If you’d like to sign up or ask a question, get in touch with us today and get ready to take your knowledge to the next level.