If you are confronted by a serious medical problem such as acute chest pain, suspected broken bones, bad burns or severe bleeding, call an ambulance (telephone 999) or visit your nearest Accident and Emergency Centre at your discretion. If you are uncertain, you can go to NHS 111 online, or phone NHS 111 for free advice from health professionals 24 hours a day. Your call is free from land lines or mobile phones.
Illness in children can be particularly concerning for parents. The National Institute for Health and Care Excellence (NICE) has developed a “traffic light” system for identifying the risk of serious illness in children. Note: an infant or child will fall into the amber or red risk category if they have any of the relevant clinical features.
| Type | Green (low risk of serious illness) | Amber (intermediate risk of serious illness) | Red (high risk of serious illness) |
|---|---|---|---|
| Colour | Normal colour of skin, lips, and tongue. | Pallor of skin, lips, or tongue reported by parent or carer. | Pale, mottled, ashen, or blue skin, lips, or tongue. |
| Activity | Responding normally to social cues. Content and smiling. Stays awake or awakens quickly. Strong normal cry or not crying. | Not responding normally to social cues. Waking only with prolonged stimulation. Decreased activity. Not smiling. | No response to social cues. Appears ill to a healthcare professional. Unable to rouse, or if roused does not stay awake. Weak, high-pitched, or continuous crying. |
| Respiratory | — | Nasal flaring. Tachypnoea: 6–12 months of age RR* > 50 breaths per minute; > 12 months of age RR* > 40 breaths per minute. Oxygen saturation ≤ 95% in air. Crackles on chest auscultation. | Grunting. Tachypnoea: RR* 60 breaths per minute or more. Moderate or severe chest indrawing. |
| Hydration and circulation | Normal skin turgor and eyes. Moist mucous membranes. | Poor feeding in infants. Dry mucous membranes. Capillary refill time of 3 seconds or more. Reduced urine output (in infants ask about wet nappies).Tachycardia: >160 beats/minute under 1 year of age; >150 beats/minute 1–2 years of age; >140 beats/minute 2–5 years of age. | Reduced skin turgor. |
| Other | None of the amber or red symptoms or signs. | Fever for 5 days or more. Rigors. Temperature ≥ 39°C in children 3–6 months of age. | Temperature ≥ 38°C in infants 0–3 months of age |
| Swelling of limb or joint. Non weight-bearing or not using a limb. | Non-blanching rash. Bulging fontanelle. Neck stiffness. Focal neurological signs. Focal seizures. Status epilepticus. |
Key
- CRT, capillary refill time; RR, respiratory rate
- NB: Some vaccinations have been found to induce fever in children aged under 3 months
For more information, go to /www.nice.org.uk/guidance/ng143
Parents may find it helpful to visit “When Should I Worry?“.
Weekend And Night Cover
For emergency medical attention when the surgery is closed, please telephone NHS 111 (just dial 111) who will put you in touch with the surgery’s out of hours doctor service if necessary.