Published online Dec 9, 2026. doi: 10.5409/wjcp.125891
Revised: August 5, 2026
Accepted: September 4, 2026
Published online: December 9, 2026
Processing time: 62 Days and 4.8 Hours
Fever is one of the most common reasons for pediatric medical consultations worldwide. Although numerous clinical practice guidelines (CPGs) have been developed to support evidence-based fever management, variations in recommen
To compare recommendations from contemporary national and international pediatric fever CPGs and identify areas of consensus and divergence.
A systematic literature search was conducted in MEDLINE, Scopus, Web of Science, the Cochrane Library, guideline repositories, and relevant organizational websites. National and international pediatric fever CPGs published or updated between January 1, 2010, and June 12, 2026, were eligible. Recommendations were extracted using a standardized form and grouped into four predefined domains: Temperature assessment, antipyretic therapy, physical methods, and caregiver education. Agreement across guidelines was classified as excellent (≥ 80%), partial (60%-79%), or low (< 60%).
Eleven CPGs met the inclusion criteria. Excellent agreement (≥ 80%) was observed for recommendations on the indication for antipyretic treatment, use of paracetamol and ibuprofen, and caregiver education (all 100%), as well as for avoiding the use of fever alone as an indicator of serious bacterial infection and against the use of antipyretics for the prevention of febrile seizures (both 91%). By contrast, recommendations on temperature measurement sites showed the greatest variability across guidelines. Partial agreement (64%) was observed for body temperature thresholds, vaccination prophylaxis, tepid sponging, and routine combined antipyretic therapy, while alternating antipyretic therapy showed the lowest agreement among antipyretic-related recommendations (55%). Recommended maximum daily paracetamol doses also varied substantially, ranging from 40 mg/kg/day to 90 mg/kg/day.
Contemporary pediatric fever CPGs show broad consensus on antipyretic therapy and caregiver education, but recommendations on temperature assessment, physical methods, and paracetamol dosing remain more variable, warranting harmonization.
Core Tip: This systematic review compared recommendations from 11 contemporary national and international clinical practice guidelines for pediatric fever management. Despite broad agreement regarding the use of antipyretics for relieving discomfort and the importance of caregiver education, important differences remain in fever definitions, temperature measurement, physical cooling methods, and antipyretic dosing recommendations. These findings identify areas of international consensus and ongoing variation, providing clinicians with a practical overview of contemporary recommendations and highlighting priorities for future guideline harmonization.