Fever and Pain in Italian Children: What Pediatricians Really Do

<b>Background:</b> Fever and pain are among the most frequent symptoms in pediatric care, requiring timely and appropriate management. While evidence-based guidelines are available, adherence in real-world practice remains variable. This study aimed to explore the attitudes and prescribing behaviors of Italian Primary Care Pediatricians (PCPs) in the management of fever and pain, and to assess their alignment with current clinical recommendations. <b>Materials and Methods:</b> An anonymous, cross-sectional survey consisting of 30 multiple-choice questions was administered to 900 PCPs between 1 July and 30 October 2024. The questionnaire assessed therapeutic preferences, dosing strategies, and perceived knowledge gaps. Invitations were distributed via pediatric scientific societies and regional professional networks. <b>Results:</b> A total of 244 PCPs completed the survey (response rate 27.1%). The majority were aged over 55 years (72.1%), worked in urban settings (71.3%), and had more than 20 years of clinical experience (74.6%). Most respondents (77%) reported managing pediatric fever or pain on a daily basis. Paracetamol was the preferred first-line treatment for fever (95.9%), primarily due to its perceived safety (82.4%). Ibuprofen was favored by 51.6% of those who selected it for its greater effectiveness. The alternating use of paracetamol and ibuprofen for fever was never adopted by 49.6%, while 31.6% employed this strategy, believing it to be more effective. For pain, 67.6% used paracetamol and 26.2% used ibuprofen as first-line treatments; 15.2% reported alternating the two drugs. Correct dosage practices were followed by 63.9% for both medications, although 40.2% did not differentiate dosages between fever and pain management. <b>Conclusions:</b> While general trends showed alignment with current guidelines, notable inconsistencies were observed in drug selection, dosage, and the use of alternating therapies. These findings highlight a pressing need to improve the dissemination and implementation of pediatric fever and pain management guidelines among PCPs in order to reduce unsafe practices, avoid therapeutic errors, and prevent unnecessary strain on emergency care services.