Recurrent fevers in children: Could it be a periodic fever syndrome?
By Associate Professor Alberto Pinzon Charry
Paediatric allergist and immunologist in Woolloongabba, Brisbane
A child who develops repeated fevers every few weeks can leave families searching for answers.
One moment they are completely well, and the next they are unwell again with high temperatures, swollen glands, mouth ulcers or pain, only for the cycle to repeat itself weeks later.
While recurrent infections are common in childhood, some children experience repeated fevers due to a group of conditions known as periodic fever syndromes or autoinflammatory diseases.
What are periodic fever syndromes?
Periodic fever syndromes are conditions that cause episodes of inflammation in the body. Unlike typical infections, these fevers are not caused by bacteria or viruses. Instead, the immune system becomes overactive and triggers inflammation when it shouldn’t.
Children with these conditions are often completely healthy between episodes, but develop fevers and other symptoms that may follow a noticeable pattern.
What are the symptoms?
The main feature is recurrent fever, but children may also experience:
- mouth ulcers
- sore throat
- swollen lymph nodes
- abdominal pain
- joint pain or swelling
- skin rashes
- fatigue during episodes.
Some children experience episodes every few weeks with remarkable predictability, while others have a less obvious pattern.
One of the most common conditions: PFAPA
One of the better-known periodic fever syndromes in children is PFAPA syndrome, which stands for:
- periodic fever
- aphthous stomatitis (mouth ulcers)
- pharyngitis (sore throat)
- adenitis (swollen glands).
PFAPA usually begins in early childhood and does not typically cause long-term damage. However, the repeated episodes can still be disruptive for children and families, particularly when they affect sleep, school attendance and daily routines.
Why diagnosis can take time
Periodic fever syndromes can be difficult to identify because the symptoms often resemble common childhood illnesses.
Children may initially be treated for recurrent viral infections or tonsillitis before patterns begin to emerge. Diagnosis usually involves:
- a detailed medical history
- looking for patterns in fever episodes
- physical examination
- blood tests during and between episodes
- excluding infections, autoimmune conditions and other causes.
Keeping a symptom diary can be very helpful. Recording when fevers occur, how long they last, and any associated symptoms may help identify patterns over time.
When should parents seek specialist advice?
Most childhood fevers are caused by common infections and are not a sign of a periodic fever syndrome. However, parents may wish to seek further assessment if:
- fevers keep recurring without a clear explanation
- episodes seem to follow a pattern
- symptoms continue over many months
- the child has ongoing mouth ulcers, rashes or joint pain
- blood tests repeatedly show inflammation
- the fevers significantly impact daily life.
A paediatric allergist and immunologist can help investigate whether an autoinflammatory condition may be contributing to recurrent symptoms.
Can periodic fever syndromes be treated?
Treatment depends on the specific condition and severity of symptoms.
For some children, episodes may improve naturally over time. Others may benefit from medications that help reduce inflammation or shorten episodes.
Management plans are highly individualised and may involve monitoring symptoms, treating flare-ups, preventing future episodes, and supporting overall quality of life
The good news is that many children with periodic fever syndromes go on to live healthy, active lives once the condition is recognised and appropriately managed.
