Background: Fever in children is one of the most common clinical symptoms and a frequent cause of caregiver concern. It is a normal body response to a variety of conditions, the most common of which is infection. Many childhood illnesses are accompanied by fever, which is often treated at home prior to presentation at a health facility. Nearly every child will develop a febrile episode at some point in life. The challenge for caregivers is to know when to be concerned and how to manage such episodes appropriately when they occur. Caregiver knowledge and perceptions regarding fever are an important determinant of their fever management practices. Objective: The purpose of this study was to determine knowledge, perceptions and management practice of fever among caregivers of children under-five presenting with acute febrile illnesses in an urban tertiary care hospital accident and emergency department. Study design: A cross sectional study carried out at the Aga Khan University Hospital paediatric accidents and emergencies department. Methods: Quantitative data was collected using a structured questionnaire administered by the lead investigator and assistant to caregivers accompanying febrile children aged below five years who presented at the paediatric casualty. The primary outcomes were the knowledge, perceptions and home management practices of fever amongst caregivers and the secondary outcomes were the socio-demographic characteristics of caregivers that influence knowledge, perceptions and home management of fever. Data were analysed and summarised as proportions for categorical data and means/ranges for continuous data. Tests of association between socio-demographic factors and the various responses on knowledge, perceptions and practice from the questionnaire choices were performed using chi-square and student’s t test for categorical and continuous variables respectively. Regression analysis was used to control for interaction effects and confounders. Results: Majority (98%) of caregivers were able to define fever adequately and were able to correctly deduce that fever was as a result of underlying illness and not a disease pathology on its own. Majority of caregivers (95.7%) experienced great anxiety when confronted with fever. Most (94.8%) caregivers did not feel confident managing fever in children at home and relied heavily on antipyretics to allay their anxiety. Knowledge on antipyretic indications and adverse effects was poor with 100% of caregivers not being aware of the fact that antipyretics had adverse effects. Healthcare providers constituted the greatest (92.9%) source of information to caregivers of febrile children. Caregiver education emerged as the greatest determinant of caregiver knowledge