Summary: One of the critical issues in paediatrics is managing pain and fever. Controlling them is an essential element of therapy, ensuring optimal conditions for recovery. However, the range of available drugs in children is much more limited than in adults due to safety profiles, scopes of registration, and the availability of age-appropriate formulations. Paracetamol and ibuprofen remain the foundation of pain and fever treatment in children. However, where their activity is insufficient, it is worth reaching for metamizole – a highly effective drug, lacking the disadvantage of gastrotoxicity and available in many forms. The increased risk of agranulocytosis after metamizole administration, described over the years, is much lower than it used to be believed. However, we should not forget about it entirely and use metamizole as a second-line therapy for the shortest possible time.