Aim: The use of antipyretics to manage the febrile child is becoming increasingly popular. Paracetamol and ibuprofen are the most commonly used interventions to manage fever in children; however, there have been no comparative analyses. The aim of the study is to evaluate the evidence comparing paracetamol to ibuprofen in the treatment of fever in children. Methods: A systematic review of randomised controlled trials investigating the administration of oral paracetamol and ibuprofen to reduce fever in children. Children aged 1 month to 12 years with a temperature between 37.5 and 41°C were included. A total of 3023 papers were identified. After removal of duplications, application of inclusion criteria and screening, eight papers were subjected to critical appraisal and included in this study. Results: Six of the studies identified that ibuprofen was slightly, but not significantly, better at reducing fever in children than paracetamol. Dosage variances and route of temperature measurement ranged between studies, limiting the comparability of studies. While ibuprofen was reported to be marginally more effective at reducing fever and fever associated discomfort in children, there is insufficient data to conclude that ibuprofen is superior to paracetamol. Conclusion: There is little evidence supporting the superior efficacy of paracetamol or ibuprofen in the treatment of fever in children with indications that both drugs are equally effective.