Background and Rational: Fever is a common illness in children. Fever accounts for about 30% of all chief complaints in children presenting at emergency ward of the Childrens’ Hospital, Vientiane. Objective: To compare the efficacy of fever management using rectal paracetamol plus tepid sponge (Group 1) versus rectal paracetamol plus fever cooling sheet (Group 2) in children aged 2 months to 5 years. Methodology: We conducted a randomized controlled trial at the emergency ward of the national Children Hospital, Vientiane Capital, Lao PDR. Fever was defined as axillary temperature of ≤38.5°C. The study was from 1st June to 1st September 2018. The doses of paracetamol used were 80 mg, 125 mg and 250 mg for children weighed 3-<6 kg, 6-10 kg and >10-<15 kg, respectively. Consent ethics Result: One hundred children enrolled in the study, 50 children in Group 1 and 50 in Group 2. The most common febrile illness in our study was the common cold. There was no significant difference of proportion of common colds in both groups (45.8% vs 39.2% in Group 1 and Group 2, respectively). The average temperature prior to treatment was 38.69°C and 38.78 °C for Group 1 and Group 2, respectively. After 15 minutes of the treatment, the temperature reduced to 38.43°C and 38.67°C, reduced to 38.13°C and 38.55°C in 30 minutes and to 37.62°C and 38.41°C in 60 minutes later for Group 1 and Group 2, respectively. The temperature at 60 minutes after the treatment was significantly lower in Group 1 (p=0.021). The proportion of children with normal temperature ( ≥37.5°C) was significantly higher Group 2 than Group 1 (18.7% vs 0%, respectively; p=0.01). The side effect of the treatment (irritation) in 60 minutes later was significantly higher in Group 2 as compared to Group 1 (76.9% vs 23.1%, p=0.006). Conclusion Rectal paracetamol plus tepid sponge was more efficacious than rectal paracetamol plus fever cooling sheet in lowering the temperature in children. Therefore, tepid sponge should be highly recommended to avoid the side effects derived from fever cooling sheet.