Abstract：Objective：To systematically evaluate the efficacy and safety of Chinese medicine external treatment as an adjunct therapy for pediatric exogenous fever using network meta-analysis（NMA）．Methods：A comprehensive search was conducted in PubMed， Embase， Cochrane Library， China National Knowledge Infrastructure（CNKI）， Wanfang Database， VIP， and China Biomedical Literature Database for randomized controlled trials （RCTs） on Chinese medicine external treatment for pediatric exogenous fever from January 2010 to June 2023． Two researchers independently screened the literature，extracted data，and assessed the risk of bias in the included studies according to predefined criteria． NMA was performed using R-4.3.1 software． Results： A total of 30 RCTs involving 5 888 participants and 19 different interventions were included．The NMA results showed that，in terms of clinical efficacy， compared to conventional basic treatment alone，the combination of conventional basic treatment with Chinese medicine external treatments such as enema， application therapy， bloodletting， medicinal bath， and massage， or the single use of enema+bloodletting， bloodletting+massage， medicinal bath+massage， scraping， enema， medicinal bath， massage， bloodletting + foot bath， medicinal bath + acupuncture and moxibustion， foot bath， bloodletting， and application therapy， were all more effective than conventional basic treatment alone． Medicinal bath had the highest probability of reducing the incidence of adverse events． Enema combined with conventional antipyretic treatment had the shortest time to onset of fever reduction． The complete fever reduction time was shorter with the combination of conventional basic treatment and medicinal bath，or with the use of enema+bloodletting，foot bath，and enema alone， compared to conventional basic treatment alone．Conclusion：The rational use of Chinese medicine external treatment in addition to conventional western medicine can improve clinical efficacy，reduce the adverse reactions，and shorten the time to onset and complete fever reduction in pediatric patients with exogenous fever．However，due to the lack of direct comparisons among different Chinese medicine external treatments， these conclusions need to be validated by more high-quality studies.