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Mayo Clinic Q and A: Child with recurrent fever may have periodic fever syndrome
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DEAR MAYO CLINIC: Every few weeks my toddler will develop a fever that lasts a couple of days but then goes away. Other than the fever, she doesn’t have any other symptoms. Could it be periodic fever syndrome? How is that diagnosed, and is treatment for it different than treating a “normal” fever in kids?
ANSWER: From your description, it sounds like your child could have periodic fever syndrome. Make an appointment with her doctor to have the condition evaluated. A diagnosis of periodic fever syndrome is based on symptoms. Effective treatment is available.
A fever is a rise in body temperature. It’s often a sign of infection, but not always. The fever itself generally doesn’t cause any harm. In fact, it can act as a protective mechanism, helping to rid the body of bacteria, viruses and other causes of infection.
Average body temperature is 98.6 degrees Fahrenheit, or 37 degrees Celsius. But normal body temperature can range from 97 F (36.1 C) to 99 F (37.2 C) or higher. Body temperature may change depending on a person’s level of activity and the time of day. In general, younger people have higher normal body temperatures than older people.
With most periodic fever syndromes, the body temperature is normal for several weeks, and then it rises quickly to a high fever — sometimes even as much as 104 F or 105 F. The fever lasts for several days, and then it goes away on its own.
Several types of periodic fever syndrome exist. The most common one is called PFAPA. That stands for periodic fever, aphthous stomatitis, pharyngitis and adenitis. Children who have this condition may develop a sore throat and mouth sores along with swelling of glands in the neck during a fever episode. With PFAPA, the fever cycle repeats about every three to five weeks. This disorder is the most common cause of fever that recurs at regular intervals in children. It often starts during the first five years of life.
The underlying cause of PFAPA is not clear. Diagnosis is based on several factors in addition to the recurring cycle of the fever. First, children who have this condition don’t have an infection, as is typical for people with a fever. Second, over-the-counter medications that usually lower fevers, such as acetaminophen or ibuprofen, have little — if any — effect on the fever. Third, although children will drink, they usually will not want to eat during an episode. Fourth, and most importantly, each fever episode is very similar to the one before.
There is no blood test for PFAPA, but testing is sometimes done to look for infection or one of the other less common periodic fever syndromes. If your child is diagnosed with PFAPA, her doctor likely will recommend a single oral dose of a corticosteroid medication such as prednisone. In most cases, that brings the body temperature back to normal within a few hours. The fever doesn’t come back again until the cycle repeats in a few weeks, when another dose of the corticosteroid can be given.
Regular treatment is recommended for PFAPA so that the child doesn’t miss school or daycare each month. Most children eventually outgrow PFAPA and no longer need medication.
Some parents worry about the effects having a high fever on a regular basis may have on their child. But this condition doesn’t cause any long-term problems. And, contrary to popular belief, a fever itself is not dangerous. Usually, it’s the infection or other illness that accompanies a fever that causes health concerns. Because there is no underlying infection with periodic fever syndrome, other than making the child feel miserable, the fever is harmless. — Thomas Boyce, M.D., Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minn.
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