Background <p>Perianal abscess is a common pediatric anorectal infectious disease, and caregivers of affected children often experience fear of disease progression. This survey aimed to evaluate the fear of disease progression among caregivers of outpatient children with perianal abscess, to provide insights for clinical nursing practice.</p> Method <p>The primary caregivers of children with perianal abscess who attended the Anorectal Surgery Outpatient Clinic of hospital from January 2025 to July 2025 were included. Data were collected using a structured questionnaire (including general information and a validated Fear of Disease Progression Scale with Cronbach’s α = 0.894). Clinical trial number: not applicable.</p> Results <p>A total of 214 primary caregivers were included. The caregivers showed a moderately high level of fear of disease progression (46.18 ± 9.20), with the highest score in the Emotional Response dimension. Children’s age(r = -0.590), only-child status(r = 0.588), caregivers’ age (r = -0.585), educational background (r = -0.601) and household residence(r = 0.615) were correlated with fear scores (all <i>P</i> &lt; 0.05). Multiple linear regression (R² = 0.596, P &lt; 0.001) identified those key influencing factors: Positive predictors included household residence (<i>P</i> = 0.001), child’s only-child status (<i>P</i> = 0.017), and younger caregiver age (<i>P</i> = 0.024). Negative predictors included higher caregiver educational background (P = 0.008) and older child age (<i>P</i> = 0.014).</p> Conclusion <p>Fear of disease progression in these caregivers is jointly affected by child-related, caregiver-related, and environmental factors. Clinical nursing should adopt targeted interventions (hierarchical psychological counseling, precision information support, family function collaboration) and integrate emotional assessment into routine care to improve caregiver mental health and family care quality.</p>