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Guidelines for the care of infants and children from birth to age 3 who have a fever of unknown origin were set forth. Such children constitute a significant proportion of ambulatory pediatric visits to physicians' offices and emergency departments. The guidelines developed by an expert panel called for hospitalization of infants and children and all febrile infants less than 28 days old for parenteral therapy, outpatient treatment and careful surveillance of low-risk febrile infants 28 to 90 days of age, and no laboratory tests or antibiotics for older children with a fever of less than 39 degrees C. The panel called for treatment of children 3 to 36 months with a fever of 39 degrees C or more and with a white blood bell count of 15,000/mm3 or more with antibiotics pending the outcome of a blood culture. It also stated that urine cultures be taken from all boys 6 months of age or less and from all girls 2 years of age or less who were being treated with antibiotics., Study objective. To develop guidelines for the care of infants and children from birth to 36 months of age with fever without source. Participants and setting. An expert panel of senior academic faculty with expertise in pediatrics and infectious diseases or emergency medicine. Design and intervention. A comprehensive literature search was used to identify all publications pertinent to the management of the febrile child. When appropriate, meta-analysis was used to combine the results of multiple studies. One or more specific management strategies was proposed for each of decision nodes in draft management algorithms. The draft algorithms, selected publications, and the meta-analyses were provided to the panel, which determined the final guidelines using the modified Delphi technique. Results. All toxic-appearing infants and children and all febrile infants less than 28 days of age should be hospitalized for parenteral antibiotic therapy. Febrile infants 28 to 90 days of age defined at low risk by specific clinical and laboratory criteria may be managed as outpatients if close follow-up is assured. Older children with fever less than 39.0 [degees] C without source need no laboratory tests or antibiotics. Children 3 to 36 months of age with fever of 39.0 [degrees] C or more and whose white blood cell count is 15 000/[MM.sup.3] or more should have a blood culture and be treated with antibiotics pending culture results. Urine cultures should be obtained from all boys 6 months of age or less and all girls 2 years of age or less who are treated with antibiotics. Conclusion. These guidelines do not eliminate all risk or strictly confine antibiotic treatment to children likely to have occult bacteremia. Physicians may individualize therapy based on clinical circumstances or adopt a variation of these guidelines based on a different interpretation of the evidence. Pediatrics 1993;92:1-12; practice guidelines, fever without source, bacteremia.