• Not responding normally to social cues • No smile • Wakes only with prolonged stimulation • Decreased activity
Normal colour of skin, lips or tongue
• Responds normally to social cues • Content/smiles • Stays awake or awakens quickly • Strong normal cry/not crying
• Normal skin and eyes • Moist mucous membranes
• Age <3 months, temperature ≥38°C* • Non-blanching rash • Bulging fontanelle • Neck stiffness • Status epilepticus • Focal neurological signs •Focal seizures
Pale/mottled/ashen/blue skin
Pallor reported by parent/carer
• Tachycardia: o >160 beats/minute, age <12 months o >150 beats/minute, age 12–24 months o >140 beats/minute, age 2–5 years • Capillary refill time ≥3 seconds • Dry mucous membranes • Poor feeding in infants Reduced urine output
• Grunting • Tachypnoea: respiratory rate >60 breaths/minute Moderate or severe chest indrawing
• 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
• Age 3–6 months, temperature ≥39°C • Fever for ≥5 days • Rigors • Swelling of a limb or joint Non-weight bearing limb/not using an extremity
• Nasal flaring • Tachypnoea: respiratory rate o >50 breaths/minute, age 6–12 months; o >40 breaths/minute, age >12 months • Oxygen saturation ≤95% in air Crackles in the chest
Reduced skin turgor
None of the amber or red symptoms or signs