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Optimizing pharmacological management of the febrile child

Marco Bianchi1, Mattia Costa1, Fabio Cardinale2

  • 1Pediatrics Unit, Neuroscience, Mental Health and Sense Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.

Expert Opinion on Pharmacotherapy
|November 21, 2025
PubMed

Insights

Pediatric fever management should prioritize child comfort over normalizing temperature, as fever is a defense mechanism, not a disease. Addressing parental anxiety (

Area of Science:

  • Pediatrics
  • Clinical Medicine
  • Pharmacology

Background:

  • Parental anxiety regarding pediatric fever ('fever phobia') often leads to inappropriate antipyretic use.
  • Fever is a physiological host defense mechanism, not inherently a disease state.
  • Current management paradigms are shifting from a temperature-centric to a child-centric approach.

Purpose of the Study:

  • To synthesize evidence supporting clinical decision-making in pediatric fever management.
  • To reframe fever as a beneficial physiological response rather than a condition requiring solely temperature reduction.
  • To guide clinicians toward prioritizing patient comfort and judicious use of antipyretics.

Main Methods:

  • Narrative review of current scientific evidence.
  • Analysis of misconceptions surrounding fever height and antipyretic response.
  • Evaluation of evidence-based temperature measurement and pharmacological/non-pharmacological management strategies.

Main Results:

  • Fever height and response to antipyretics are poor indicators of illness severity.
  • Paracetamol and ibuprofen are recommended first-line pharmacological agents.
  • Non-pharmacological comfort measures, including hydration, are crucial components of care.

Conclusions:

  • Clinical judgment, focusing on the child's overall well-being, should guide management over isolated temperature readings.
  • Overcoming 'fever phobia' requires education and improved clinical guidelines.
  • Future research should focus on diagnostics, biomarkers, long-term antipyretic effects, and educational interventions.
Abstract

Keywords:
Pediatric feverantipyreticsfever managementfever phobiaibuprofenmisconceptionsparacetamolthermometer

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