This article brings reflections on how the play moment in school can be configured as a strategy that favors or tensions the medicalization logic. From the fetish concept of historical-dialectical materialism, evidence as an idealized conception of childhood, and nature form the basis for the rise of medicalized play; then, starting from the foundations of historical-cultural psychology, we present theoretical principles that may guide a playful pedagogical practice that problematizes medicalization. We hope that the work will contribute to building unmedicalizing practices within the school environment.