Parental management of childhood fever and associated factors in southeastern Brazil: a cross-sectional study

OBJECTIVE: To evaluate parental and caregiver practices in the management of childhood fever and to identify factors independently associated with appropriate fever management according to Brazilian Pediatric Society recommendations. METHODS: A cross-sectional study was conducted in 2024 using a structured questionnaire administered both online and in person at primary health care units. A total of 847 parents or caregivers of children and adolescents participated in the study. Fever management was considered appropriate only when all predefined diagnostic and therapeutic criteria were met simultaneously. Associations were assessed using chi-square tests and multivariable logistic regression. RESULTS: 60.7% (n = 514) of responses were collected online and 39.3% (n = 333) in person. Only 42% of caregivers fulfilled all predefined criteria for appropriate fever management. In bivariate analyses, appropriate management was associated with both educational level and time elapsed before seeking medical care. However, after multivariable adjustment, educational level was no longer significantly associated with the outcome, whereas only time to medical consultation remained independently associated. Compared with immediate consultation, caregivers who waited 6-12 h (OR = 1.91; 95% CI: 1.16-3.16), 12-24 h (OR = 1.96; 95% CI: 1.20-3.20), or 24-36 h (OR = 1.67; 95% CI: 1.02-2.75) were more likely to manage fever appropriately. CONCLUSIONS: Less than half of caregivers managed childhood fever appropriately. A short period of observation before seeking medical care was independently associated with better adherence to recommended practices. These findings highlight persistent gaps in home-based fever management and suggest that caregiver decision-making regarding healthcare-seeking may be a relevant target for future educational interventions.