Objectives The objective of the study was to determine the epidemiology of febrile children presenting to the emergency room (ER) and examine reasons for antimicrobial prescriptions. Methods Charts of children ≤ 10 years with a temperature ≥ 38.5 between December 21, 1996 and January 21, 1997 were reviewed. Results 537 visits were reviewed. 417 (77.5%) children were ≤ 2 years. 333 of 537 (62%) presented with less than 48 hours of fever. 367 of 537 (68%) presented with upper respiratory symptoms (nasal congestion, rhinitis, sore throat) or cough. 336(62.6%) had no laboratory investigations. All 107 blood cultures were negative. 50 (9.3%) had viral tests (VT) for respiratory viruses. Of these, 42(84%) were positive: 15 (36%) respiratory syncytial virus (RSV), 17 (40%) Influenza A, 5 (12%) Influenza B, and 5 (12%) parainfluenza. 8 of 50 (16%) patients diagnosed with pneumonia had VT; 6 (75%) were positive (1 RSV, 4 Influenza A, and 1 parainfluenza). The most common ER diagnoses were: viral illness 128 (23.8%), upper respiratory tract illness (URI) 95 (17.7%), otitis 96 (17.9%), pneumonia 50 (9.3%), pharyngitis 32 (6%), febrile seizure 34(6.3%). 272 (50.6%) left without antimicrobials, 68 (12.6%) were already on antimicrobials when initially assessed, and 197 (36.6%) were given a prescription for antimicrobials. The percentage of children who left the ER with antimicrobials by diagnosis is as follows: viral illness 18/128 (14%), upper respiratory infection 21/95 (22%), otitis 95/96 (99%), pneumonia 50/50(100%), pharyngitis 27/32 (84%), febrile seizure 16/34 (47%), bronchiolitis 4/19 (21%), reactive airway disease 5/17 (29%), urinary tract infection 12/12(100%). Of 266 patients who received antimicrobials, amoxicillin was prescribed in 144 (54%) cases and 32 (12%) of 266 were admitted for intravenous antimicrobial therapy. Conclusions Most febrile children who present to the ER in the winter with fever are less than 2 years, have less than 48 hours of fever and have upper respiratory symptoms. When a viral etiology is sought, it is found in a large proportion of cases. Patients with illnesses usually caused by viruses (ie. URI, bronchiolitis, and pneumonitis) were given antimicrobials in 14% to 100% of cases. This information will help us target educational initiatives with the aim of optimal utilization of antimicrobials.