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    AT is impractical for use as a screening test for fever because of poor sensitivity and high rate of false positive. When a child presents to a clinic or is admitted to the hospital with a complaint or history of fever, AT should not be used. The order of AT/RT measurements was randomly allocated at admission, form of randomization not reported, . In cases where the clinical benefit of a specific test or intervention has not been established, the recommendation is that these tests should not be performed, thus increas­ ing the potential cost­effectiveness of care in this setting. In addition to look­ ing for these features, the clinician will look for a focus of infection or other symptoms and signs that might suggest a particular diagnosis, . Recommendation on clinical assessment by the paediatric specialist Management by the paediatric specialist should start with a clinical assessment as described in Chapter 4 The healthcare professional should attempt to identify symptoms and signs of serious illness and specific diseases as summarised in Tables 4. Hospital Episode Statistics suggest that the incidence of the serious illnesses defined in this guideline are 19 316 per 100 000 for infants less than 3 months old in England, compared with 1400 per 100 000 for all children less than 5 years old. The neonate is at risk of rapidly developing infection because of a relatively poorly developed immune system and of permanent disability, especially from meningitis. Babies born preterm or with low birthweight are particularly vulnerable.

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