Optimizing pharmacological management of the febrile child

Introduction: Pediatric fever often causes significant parental anxiety, or 'fever phobia,' leading to the inappropriate use of antipyretics. This narrative review synthesizes current evidence to support clinical decision-making, framing fever as a regulated physiological host defense mechanism, not a disease. The primary therapeutic goal is improving the child's overall comfort, rather than simply normalizing body temperature. Areas covered: This review dispels common misconceptions, clarifying that fever height and response to antipyretics are poor predictors of illness severity. We cover evidence-based approaches to temperature measurement and the pharmacological management of symptoms, focusing on paracetamol and ibuprofen as first-line agents. Non-pharmacological strategies, such as hydration and comfort care, are described. Ultimately, we underscore the importance of clinical judgment over isolated temperature readings to guide appropriate management. Expert opinion: The management of pediatric fever is shifting from a temperature-centric paradigm to a child-centric approach focused on comfort and reducing medication misuse. Future progress hinges on harmonizing inconsistent clinical guidelines and developing advanced point-of-care diagnostics to better stratify the risk of serious bacterial infections. Overcoming 'fever phobia' remains a key challenge, requiring education and scalable digital tools. Key research priorities include validating novel biomarkers, clarifying the long-term effects of antipyretics, and implementing effective educational programs.