🔁 Recurrent Fevers in Children: What Is PFAPA and When Should You Be Concerned?

🎯 “My child seems to get a high fever every month — the same way, at the same time — but all the tests come back normal.”

This pattern is often seen in a group of conditions called recurrent fever syndromes, or periodic fever syndromes.

These are auto-inflammatory disorders, where the immune system becomes activated without an infection.

In this blog, we’ll explore the most common type — PFAPA syndrome — as well as other conditions like Familial Mediterranean Fever (FMF) and how to know when to seek a pediatric evaluation.

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📌 What Is PFAPA Syndrome?

PFAPA is the most common cause of recurrent fever in young children.

The name stands for:

• P: Periodic

• F: Fever

• A: Aphthous stomatitis (mouth ulcers)

• P: Pharyngitis (sore throat)

• A: Adenitis (swollen lymph nodes in the neck)

🧩 Key Features:

✅ Sudden episodes of high fever every 3–6 weeks

✅ Each episode looks exactly the same and lasts 3–5 days

✅ The child is completely healthy between attacks

✅ No antibiotics are effective during episodes

✅ Starts between ages 2 and 5, often resolves by age 10

🤒 Common symptoms:

• High fever

• Red or sore throat

• Swollen neck glands

• Mouth ulcers

• Fatigue and poor appetite during attacks

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🔬 What Causes It?

PFAPA is not an infection and usually not inherited.

It’s considered an auto-inflammatory condition, where the immune system mistakenly triggers inflammation at regular intervals.

Unlike other periodic fever syndromes (like FMF), PFAPA does not have a known genetic mutation.

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🧪 How Is It Diagnosed?

There is no single test for PFAPA. Diagnosis is clinical, based on:

• The child’s detailed fever history

• Presence of consistent symptoms in each episode

• Normal growth and development

• Exclusion of other causes (chronic infections, immune deficiency, FMF)

Your pediatrician may order:

• CBC, CRP, ESR (inflammation markers)

• Throat cultures

• FMF genetic testing if indicated

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💊 Treatment Options

1. Supportive care during fever episodes

2. A single dose of corticosteroid (e.g. prednisolone) often stops the fever within hours

3. For frequent episodes, colchicine or immune-modulating treatments may be considered

4. In some cases, tonsillectomy (removal of tonsils) has shown benefit

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🔄 Other Periodic Fever Syndromes:

📌 These conditions often require referral to pediatric rheumatology.

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👨‍⚕️ When Should You See a Doctor?

• Recurrent high fever episodes every 3–6 weeks

• Fever not responding to antibiotics

• Swollen neck glands, sore throat, and mouth ulcers during fever

• Family history of FMF or other autoimmune conditions

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📌 Final Thoughts

Not all fevers are infections.

If your child has predictable, repeated fever episodes with the same symptoms every time, they may have PFAPA or another periodic fever syndrome. These are manageable conditions, but early recognition is key.

🩺 If you’re in İzmir and would like your child evaluated for recurrent fevers, we would be happy to welcome you at our pediatric clinic.