The goal of this review is to summarize the currently available literature pertaining to meningococcal disease as it relates to the complaint or fever and petechiae, From this review a management strategy is suggested for children who present with fever and a petechial rash. In general, invasive bacterial disease, including meningococcemia, in the child with fever and petcehiae is rare, The vast majority of children with invasive bacterial disease appear ill or have an abnormal laboratory evaluation. Children who are well-appearing, who have a normal laboratory evaluation, or who have a documented streptococcal pharyngitis or petechiae only above the nipple line appear to be at low risk for invasive bacterial disease. Children identified to be at low risk may be managed as an outpatient. All others should he admitted to the hospital and treated with antibiotics pending culture results.